Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 2008030024 | MO |
N | 225XG0600X | Occupational Therapist - Gerontology | ||
N | 225XP0200X | Occupational Therapist - Pediatrics | ||
N | 225XP0200X | Occupational Therapist - Pediatrics | 2008030024 | MO |
NPI | 1346485901 |
---|---|
Provider Name | Ms. Lindsey Marie Johnson |
First Address | St. Louis, MO 63119 |
Second Address | Saint Louis, MO 63119-4322 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2008 |
Last Update Date | 04/09/2019 |