Provider Demographics
NPI:1255619912
Name:WEINFURTNER, LINDSAY JOAN (COTA)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:JOAN
Last Name:WEINFURTNER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6010 SIPPERLEY TRL
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48838-6703
Mailing Address - Country:US
Mailing Address - Phone:616-835-3185
Mailing Address - Fax:
Practice Address - Street 1:6010 SIPPERLEY TRL
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838
Practice Address - Country:US
Practice Address - Phone:616-835-3185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-29
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR239545174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist