Provider Demographics
NPI:1841510476
Name:MITCHELL, LINDSEY GRACE (OT)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:GRACE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1725
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:TX
Mailing Address - Zip Code:75862-1725
Mailing Address - Country:US
Mailing Address - Phone:903-391-3947
Mailing Address - Fax:936-594-8953
Practice Address - Street 1:103 EVA ST
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:TX
Practice Address - Zip Code:75862-7211
Practice Address - Country:US
Practice Address - Phone:903-391-3947
Practice Address - Fax:936-594-8953
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-05
Last Update Date:2010-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109545225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist