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General NPI Number Information
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NPI Number | 1912451311
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Entity Type | Individual
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Provider Name | LINDSAY ELLYN CANCEL MOT, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 08/15/2016
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Last Update Date | 09/30/2021
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Provider Practice Location Address
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Address Line | 12276 SAN JOSE BLVD STE 508
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City | JACKSONVILLE
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State | FL
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Zip | 32223-8618
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Country | US
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Telephone | 904-886-3228
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Fax |
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Provider Business Mailing Address
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Address Line | 317 COTTAGE AVE
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City | JACKSONVILLE
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State | FL
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Zip | 32206-3513
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Country | US
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Telephone | 239-560-2884
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT17827
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License Number State | FL
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