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Individual
LINDSAY A. DEZELAN
Active
Individual
LINDSAY A. DEZELAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.T.
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
31004976A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000667631
ANTHEM PROVIDER NUMBER
IN
05
—
200986800
—
IN
Enumeration date
05/19/2010
Last updated
01/18/2017
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