Provider Demographics
NPI:1861868044
Name:JOSEPH, LINDSAY M (COTA)
Entity type:Individual
Prefix:MRS
First Name:LINDSAY
Middle Name:M
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:
Other - Last Name:TANNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:54567 VONTZ CIR
Mailing Address - Street 2:
Mailing Address - City:CALLAHAN
Mailing Address - State:FL
Mailing Address - Zip Code:32011-4797
Mailing Address - Country:US
Mailing Address - Phone:586-943-5127
Mailing Address - Fax:
Practice Address - Street 1:36261 OKEFENOKEE DR
Practice Address - Street 2:
Practice Address - City:FOLKSTON
Practice Address - State:GA
Practice Address - Zip Code:31537-7853
Practice Address - Country:US
Practice Address - Phone:912-496-7396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA001955224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant