Provider Demographics
NPI:1104418599
Name:RICHARDSON, LINDSEY NICOLE
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:NICOLE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:NICOLE
Other - Last Name:SHARER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:176 COUNTY FARM RD
Mailing Address - Street 2:
Mailing Address - City:WICKLIFFE
Mailing Address - State:KY
Mailing Address - Zip Code:42087-9235
Mailing Address - Country:US
Mailing Address - Phone:270-933-9406
Mailing Address - Fax:
Practice Address - Street 1:867 MCGUIRE AVE
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-4036
Practice Address - Country:US
Practice Address - Phone:270-442-6168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-07
Last Update Date:2025-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056014055225X00000X
KY265399225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist