Provider Demographics
NPI:1023673654
Name:MCCOLL, LINDSEY RENEE (COTA/L)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:RENEE
Last Name:MCCOLL
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-3400
Mailing Address - Country:US
Mailing Address - Phone:636-208-2761
Mailing Address - Fax:
Practice Address - Street 1:1120 EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-3400
Practice Address - Country:US
Practice Address - Phone:636-208-2761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019007158224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant