Provider Demographics
NPI:1053755157
Name:LINDSEY, MANUELA (COTA)
Entity type:Individual
Prefix:MRS
First Name:MANUELA
Middle Name:
Last Name:LINDSEY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 W CREIGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46807-1330
Mailing Address - Country:US
Mailing Address - Phone:260-442-4556
Mailing Address - Fax:
Practice Address - Street 1:336 W CREIGHTON AVE
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46807-1330
Practice Address - Country:US
Practice Address - Phone:260-442-4556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-19
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32002354A224Z00000X
TX212056224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant