Provider Demographics
NPI:1154565224
Name:BOGGIO, LINDSAY JEAN (MS, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:LINDSAY
Middle Name:JEAN
Last Name:BOGGIO
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 BAYHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:GLEN CARBON
Mailing Address - State:IL
Mailing Address - Zip Code:62034-2973
Mailing Address - Country:US
Mailing Address - Phone:618-205-6223
Mailing Address - Fax:
Practice Address - Street 1:2114 VICTOR ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-2842
Practice Address - Country:US
Practice Address - Phone:314-954-5785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.008674225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist