Provider Demographics
NPI:1811310469
Name:HOLT, LINDSEY DIANE (MOTR/L)
Entity type:Individual
Prefix:MS
First Name:LINDSEY
Middle Name:DIANE
Last Name:HOLT
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 S LARAND DR
Mailing Address - Street 2:
Mailing Address - City:HOLTS SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:65043-1132
Mailing Address - Country:US
Mailing Address - Phone:573-680-1734
Mailing Address - Fax:
Practice Address - Street 1:93 S LARAND DR
Practice Address - Street 2:
Practice Address - City:HOLTS SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:65043-1132
Practice Address - Country:US
Practice Address - Phone:573-680-1734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-31
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013026527225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist