Healthcare Provider Details

I. General information

NPI: 1528153046
Provider Name (Legal Business Name): LESA ANN LAMB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1445 BLUEWATER WAY
CHARLESTON SC
29414-7923
US

IV. Provider business mailing address

1515 AQUABELLE LN UNIT 6303
CHARLESTON SC
29414-8185
US

V. Phone/Fax

Practice location:
  • Phone: 843-576-9667
  • Fax:
Mailing address:
  • Phone: 512-784-5331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number104117
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number104117
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number4629
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: