Healthcare Provider Details

I. General information

NPI: 1427093715
Provider Name (Legal Business Name): TAMMY J. LESAGE OTR/L, CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 TREE BLVD SUITE 8
ST AUGUSTINE FL
32084-5774
US

IV. Provider business mailing address

407 CHURCH ST NE SUITE G
VIENNA VA
22180-4737
US

V. Phone/Fax

Practice location:
  • Phone: 904-829-9494
  • Fax: 904-829-9334
Mailing address:
  • Phone: 703-255-2339
  • Fax: 703-255-2402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT 2363
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: