Healthcare Provider Details

I. General information

NPI: 1245620723
Provider Name (Legal Business Name): LYNDSEY MICHELE WILLIAMS COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2015
Last Update Date: 02/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3105 BLUFF CREEK DR
COLUMBIA MO
65201-3529
US

IV. Provider business mailing address

3105 BLUFF CREEK DR
COLUMBIA MO
65201-3529
US

V. Phone/Fax

Practice location:
  • Phone: 573-442-6060
  • Fax:
Mailing address:
  • Phone: 573-442-6060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2013001307
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: