Healthcare Provider Details

I. General information

NPI: 1659870707
Provider Name (Legal Business Name): MARGARET E LESNIKOSKI ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2018
Last Update Date: 02/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 MAIN ST
DURHAM NH
03824-3572
US

IV. Provider business mailing address

145 MAIN ST
DURHAM NH
03824-3572
US

V. Phone/Fax

Practice location:
  • Phone: 603-862-3892
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0445
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: