Provider Demographics
NPI:1225865884
Name:DESSOURCES, LINDSAY NAHARA (OTRL)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:NAHARA
Last Name:DESSOURCES
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1082 JACKSON CT
Mailing Address - Street 2:
Mailing Address - City:IMMOKALEE
Mailing Address - State:FL
Mailing Address - Zip Code:34142-2767
Mailing Address - Country:US
Mailing Address - Phone:239-324-5853
Mailing Address - Fax:
Practice Address - Street 1:1082 JACKSON CT
Practice Address - Street 2:
Practice Address - City:IMMOKALEE
Practice Address - State:FL
Practice Address - Zip Code:34142-2767
Practice Address - Country:US
Practice Address - Phone:239-324-5853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-17
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25621225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty