Provider Demographics
NPI:1285098699
Name:CARLSON, LINDSEY (OT)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:CARLSON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 E ORANGE ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-5054
Mailing Address - Country:US
Mailing Address - Phone:863-617-9400
Mailing Address - Fax:863-688-9858
Practice Address - Street 1:411 E ORANGE ST
Practice Address - Street 2:SUITE 204
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-5054
Practice Address - Country:US
Practice Address - Phone:863-617-9400
Practice Address - Fax:863-688-9858
Is Sole Proprietor?:No
Enumeration Date:2016-04-12
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT15457225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist