Provider Demographics
NPI:1790315463
Name:HANCOCK, LINDSAY CAROLINE (COTA/L)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:CAROLINE
Last Name:HANCOCK
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 1:1596 SPRING ST SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-3665
Mailing Address - Country:US
Mailing Address - Phone:770-823-2347
Mailing Address - Fax:
Practice Address - Street 1:5050 RESEARCH CT STE 800
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6606
Practice Address - Country:US
Practice Address - Phone:678-749-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA002369224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant