Provider Demographics
NPI:1629148689
Name:SOUTHWELL, LINDSAY MURRAY (OT)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:MURRAY
Last Name:SOUTHWELL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:
Other - Last Name:MURRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3610 WESTHAMPTON DR
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-3036
Mailing Address - Country:US
Mailing Address - Phone:706-829-2325
Mailing Address - Fax:706-592-5565
Practice Address - Street 1:2367 HWY 88
Practice Address - Street 2:
Practice Address - City:HEPHZIBAH
Practice Address - State:GA
Practice Address - Zip Code:30815
Practice Address - Country:US
Practice Address - Phone:706-592-5565
Practice Address - Fax:706-592-5565
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4398225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA476567855BMedicaid