MEDICARE: MS. LINDSAY MARIE 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	225X00000X	Occupational Therapist	OT.008065	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14629265	OTHER	OH	CAQH

General Provider Information

NPI Number	:	1568814499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LINDSAY MARIE OTR/L

Provider Business Mailing Address
First Line	:	5000 ROCKSIDE RD STE 500
Second Line	:
City	:	INDEPENDENCE
State	:	OH
Zip	:	44131-2178
Country	:	US
Telephone Number	:	216-459-2846
Fax Number	:	216-901-2803

Provider Business Practice Location Address
First Line	:	435 W LIBERTY ST
Second Line	:
City	:	MEDINA
State	:	OH
Zip	:	44256-2221
Country	:	US
Telephone Number	:	216-749-6650
Fax Number	:	330-723-8920

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

Provider Enumeration Date	:	07/03/2016
Last Update Date	:	03/03/2020

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