MEDICARE: LINDSAY GANNON

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

General Provider Information

NPI Number	:	1639724024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDSAY GANNON

Provider Business Mailing Address
First Line	:	2787 N HOUSTON ST APT 3026
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75219-5037
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2787 N HOUSTON ST APT 3026
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75219-5037
Country	:	US
Telephone Number	:	214-934-0409
Fax Number	:

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

Provider Enumeration Date	:	08/02/2019
Last Update Date	:	08/02/2019

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Directions to “ LINDSAY GANNON ” Practice Location

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