Healthcare Provider Details

I. General information

NPI: 1184410656
Provider Name (Legal Business Name): LINDSEY RAE KOZLOWSKI OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RAE KOZLOWSKI

II. Dates (important events)

Enumeration Date: 04/19/2025
Last Update Date: 04/19/2025
Certification Date: 04/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 N NAVAJO DR
PAGE AZ
86040-0980
US

IV. Provider business mailing address

5151 E ROCK LEDGE LN
KANAB UT
84741-4113
US

V. Phone/Fax

Practice location:
  • Phone: 301-712-8700
  • Fax:
Mailing address:
  • Phone: 301-712-8700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTH-009971
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: