Provider Demographics
NPI:1508386673
Name:LINDSAY, STEPHANIE REGINA
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:REGINA
Last Name:LINDSAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 SMALL LN
Mailing Address - Street 2:
Mailing Address - City:SALUDA
Mailing Address - State:NC
Mailing Address - Zip Code:28773-9890
Mailing Address - Country:US
Mailing Address - Phone:828-702-6084
Mailing Address - Fax:
Practice Address - Street 1:185 WOODY CIR
Practice Address - Street 2:
Practice Address - City:TRYON
Practice Address - State:NC
Practice Address - Zip Code:28782-6824
Practice Address - Country:US
Practice Address - Phone:828-702-6084
Practice Address - Fax:828-894-6588
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-21
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8547224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant