Provider Demographics
NPI:1851009302
Name:HUCKABY, LINDSEY NICOLE (COTA/L)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:NICOLE
Last Name:HUCKABY
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 1:323 BRAD RD
Mailing Address - Street 2:
Mailing Address - City:HENSLEY
Mailing Address - State:AR
Mailing Address - Zip Code:72065-9725
Mailing Address - Country:US
Mailing Address - Phone:501-747-3231
Mailing Address - Fax:
Practice Address - Street 1:5550 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72019-9466
Practice Address - Country:US
Practice Address - Phone:501-943-7208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A1795224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant