Healthcare Provider Details

I. General information

NPI: 1922163617
Provider Name (Legal Business Name): LESLIE ANNE ROMANCHICK OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8115 E INDIAN BEND RD STE. 123
SCOTTSDALE AZ
85250-4819
US

IV. Provider business mailing address

8500 E SOUTHERN AVE LOT 397
MESA AZ
85209-3602
US

V. Phone/Fax

Practice location:
  • Phone: 480-951-6451
  • Fax:
Mailing address:
  • Phone: 480-357-6020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XR0403X
TaxonomyDriving and Community Mobility Occupational Therapist
License Number0956
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: