Provider Demographics
NPI:1598165979
Name:ANDERSON, LINDSEY (COTA/L)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:464-540 LENHART LN
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96114-7513
Mailing Address - Country:US
Mailing Address - Phone:931-561-1894
Mailing Address - Fax:
Practice Address - Street 1:298 WARFIELD BLVD STE C
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043
Practice Address - Country:US
Practice Address - Phone:931-906-0440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-04
Last Update Date:2018-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV15-1292224Z00000X
CA3239224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant