Healthcare Provider Details

I. General information

NPI: 1184236242
Provider Name (Legal Business Name): MICHELLE LENORE LESNICK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2020
Last Update Date: 08/20/2020
Certification Date: 08/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 LESLIE DR APT 530
HALLANDALE BEACH FL
33009-2966
US

IV. Provider business mailing address

400 LESLIE DR APT 530
HALLANDALE BEACH FL
33009-2966
US

V. Phone/Fax

Practice location:
  • Phone: 949-413-2062
  • Fax:
Mailing address:
  • Phone: 949-413-2062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License NumberOT19395
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: