Healthcare Provider Details

I. General information

NPI: 1689471666
Provider Name (Legal Business Name): LESLEY MYERS OTD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2025
Last Update Date: 02/27/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ST. JOSEPH OF THE PINES 103 GOSSMAN DR
SOUTHERN PINES NC
28387
US

IV. Provider business mailing address

480 STAR RIDGE RD
CARTHAGE NC
28327-7535
US

V. Phone/Fax

Practice location:
  • Phone: 910-246-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number15987
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: