Provider Demographics
NPI:1902203896
Name:KING, LYNDSAY (OTR/L)
Entity Type:Individual
Prefix:
First Name:LYNDSAY
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10091 SYLVARENA RD
Mailing Address - Street 2:
Mailing Address - City:WESSON
Mailing Address - State:MS
Mailing Address - Zip Code:39191-9248
Mailing Address - Country:US
Mailing Address - Phone:601-757-6540
Mailing Address - Fax:
Practice Address - Street 1:10091 SYLVARENA RD
Practice Address - Street 2:
Practice Address - City:WESSON
Practice Address - State:MS
Practice Address - Zip Code:39191-9248
Practice Address - Country:US
Practice Address - Phone:601-757-6540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-20
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT2325225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist