Healthcare Provider Details

I. General information

NPI: 1205143872
Provider Name (Legal Business Name): DIANE L. LINDSEY OTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2010
Last Update Date: 09/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4655 RUFFNER ST SUITE 270
SAN DIEGO CA
92111-2275
US

IV. Provider business mailing address

24301 CARLTON CT
LAGUNA NIGUEL CA
92677-3718
US

V. Phone/Fax

Practice location:
  • Phone: 858-505-0939
  • Fax: 858-573-0659
Mailing address:
  • Phone: 949-643-9417
  • Fax: 949-643-9427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA 1817
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: