Provider Demographics
NPI:1790243871
Name:WZOREK, LINDSEY MICHELE (OTR/L)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:MICHELE
Last Name:WZOREK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:MICHELE
Other - Last Name:KEYS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1325 BALLARD RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2303
Mailing Address - Country:US
Mailing Address - Phone:423-794-9810
Mailing Address - Fax:
Practice Address - Street 1:48 MCPRICE CT APT 414
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-6344
Practice Address - Country:US
Practice Address - Phone:423-794-9810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-07
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5492225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN115601OtherBLUE CROSS BLUE SHIELD