MEDICARE: MS. LINDSEY MARIE JOHNSON OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XG0600X	Gerontology Occupational Therapist
2	225XP0200X	Pediatric Occupational Therapist	2008030024	MO
3	225XP0200X	Pediatric Occupational Therapist
4	225X00000X	Occupational Therapist	2008030024	MO

General Provider Information

NPI Number	:	1346485901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LINDSEY MARIE JOHNSON OTR/L

Provider Business Mailing Address
First Line	:	804 TUXEDO BLVD
Second Line	:
City	:	ST. LOUIS
State	:	MO
Zip	:	63119
Country	:	US
Telephone Number	:	314-230-5024
Fax Number	:

Provider Business Practice Location Address
First Line	:	5014 DANBURY AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63119-4322
Country	:	US
Telephone Number	:	314-226-9551
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2008
Last Update Date	:	09/04/2019

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