MEDICARE: LESLIE WINSTON PAYNE OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OT13736	FL

General Provider Information

NPI Number	:	1205104734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE WINSTON PAYNE OTR/L

Provider Business Mailing Address
First Line	:	11541 DEAL RD
Second Line	:
City	:	NORTH FORT MYERS
State	:	FL
Zip	:	33917-5831
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11541 DEAL RD
Second Line	:
City	:	NORTH FORT MYERS
State	:	FL
Zip	:	33917-5831
Country	:	US
Telephone Number	:	239-543-1114
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2011
Last Update Date	:	12/12/2011

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