Healthcare Provider Details

I. General information

NPI: 1346485901
Provider Name (Legal Business Name): LINDSEY MARIE JOHNSON OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2008
Last Update Date: 09/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5014 DANBURY AVE
SAINT LOUIS MO
63119-4322
US

IV. Provider business mailing address

804 TUXEDO BLVD
ST. LOUIS MO
63119
US

V. Phone/Fax

Practice location:
  • Phone: 314-226-9551
  • Fax:
Mailing address:
  • Phone: 314-230-5024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number2008030024
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2008030024
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: