Healthcare Provider Details

I. General information

NPI: 1275301764
Provider Name (Legal Business Name): LINDSAY ALEXANDRA SPELL OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2023
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4480 CLAYTON AVE # 85054501
SAINT LOUIS MO
63110-1624
US

IV. Provider business mailing address

4480 CLAYTON AVE # 85054501
SAINT LOUIS MO
63110-1624
US

V. Phone/Fax

Practice location:
  • Phone: 314-273-5442
  • Fax:
Mailing address:
  • Phone: 314-273-5442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number2023044218
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: