Healthcare Provider Details

I. General information

NPI: 1124948443
Provider Name (Legal Business Name): LINDSEY SOPER OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67A MOUNTAIN BLVD EXT STE 1
WARREN NJ
07059-5626
US

IV. Provider business mailing address

67A MOUNTAIN BLVD EXT STE 1
WARREN NJ
07059-5626
US

V. Phone/Fax

Practice location:
  • Phone: 908-873-6337
  • Fax:
Mailing address:
  • Phone: 908-873-6337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number46TR01303500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: