Healthcare Provider Details

I. General information

NPI: 1922327352
Provider Name (Legal Business Name): LINDSEY MALONE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2010
Last Update Date: 10/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 DICKINSON RD
CHESTERTON IN
46304-3551
US

IV. Provider business mailing address

408 SANDALWOOD DR
VALPARAISO IN
46385-8118
US

V. Phone/Fax

Practice location:
  • Phone: 219-928-8162
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number057.0031712
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: