Provider Demographics
NPI:1962624361
Name:BORDA, LINDSAY MARCOULLIER (OT)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:MARCOULLIER
Last Name:BORDA
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 1:23378 TRADEWIND DR
Mailing Address - Street 2:
Mailing Address - City:BRAMBLETON
Mailing Address - State:VA
Mailing Address - Zip Code:20148-8091
Mailing Address - Country:US
Mailing Address - Phone:571-216-7647
Mailing Address - Fax:
Practice Address - Street 1:23378 TRADEWIND DR
Practice Address - Street 2:
Practice Address - City:BRAMBLETON
Practice Address - State:VA
Practice Address - Zip Code:20148-8091
Practice Address - Country:US
Practice Address - Phone:571-216-7647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119003481174400000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No174400000XOther Service ProvidersSpecialist