Provider Demographics
NPI:1487073664
Name:REISS, LINDSAY ANN (MSOT, OTR/L)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:ANN
Last Name:REISS
Suffix:
Gender:F
Credentials:MSOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2039 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-2526
Mailing Address - Country:US
Mailing Address - Phone:516-996-7260
Mailing Address - Fax:
Practice Address - Street 1:598 NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-1507
Practice Address - Country:US
Practice Address - Phone:347-221-1646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018470225X00000X
MN104591225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist