Provider Demographics
NPI:1740789429
Name:HOGAN, LINDSEY BROOKE (LCOTA)
Entity Type:Individual
Prefix:MRS
First Name:LINDSEY
Middle Name:BROOKE
Last Name:HOGAN
Suffix:
Gender:F
Credentials:LCOTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 ASHLEY ROAD 433
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:AR
Mailing Address - Zip Code:71646-9090
Mailing Address - Country:US
Mailing Address - Phone:870-853-8764
Mailing Address - Fax:
Practice Address - Street 1:219 MAIN ST
Practice Address - Street 2:
Practice Address - City:CROSSETT
Practice Address - State:AR
Practice Address - Zip Code:71635-2900
Practice Address - Country:US
Practice Address - Phone:870-364-3112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-07
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A833224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant