Provider Demographics
NPI:1710395447
Name:HUMPHREY, LINDSAY WILLIAMS (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:WILLIAMS
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:MARIE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:50 N MEDICAL DR
Mailing Address - Street 2:1R73
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84132-0001
Mailing Address - Country:US
Mailing Address - Phone:801-581-2733
Mailing Address - Fax:801-585-6234
Practice Address - Street 1:50 N MEDICAL DR
Practice Address - Street 2:1R73
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0001
Practice Address - Country:US
Practice Address - Phone:801-581-2733
Practice Address - Fax:801-585-6234
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-25
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT90485484201225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist