Provider Demographics
NPI:1639860075
Name:SKINNER, LINDSEY NICHOLE (OTR/L)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:NICHOLE
Last Name:SKINNER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:LINDSEY
Other - Middle Name:NICHOLE
Other - Last Name:SKINNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:216 S VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-6225
Mailing Address - Country:US
Mailing Address - Phone:815-382-3814
Mailing Address - Fax:
Practice Address - Street 1:525 HARVEST GATE
Practice Address - Street 2:
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156-4877
Practice Address - Country:US
Practice Address - Phone:847-957-7070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.015348225XG0600X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology