=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184410656
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LINDSEY RAE KOZLOWSKI OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2025
-----------------------------------------------------
Last Update Date | 04/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1801 N NAVAJO DR
-----------------------------------------------------
City | PAGE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86040-0980
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-712-8700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5151 E ROCK LEDGE LN
-----------------------------------------------------
City | KANAB
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84741-4113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-712-8700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | OTH-009971
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------