Provider Demographics
NPI:1316714397
Name:THEOS, LINDSEY ANSALDO (OTR)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:ANSALDO
Last Name:THEOS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1897 S UNION ST UNIT 134
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-7458
Mailing Address - Country:US
Mailing Address - Phone:714-769-4707
Mailing Address - Fax:
Practice Address - Street 1:1897 S UNION ST UNIT 134
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-7458
Practice Address - Country:US
Practice Address - Phone:714-769-4707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25792225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist