Healthcare Provider Details

I. General information

NPI: 1295394146
Provider Name (Legal Business Name): VANESSA ROCHELLE LESH OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2019
Last Update Date: 06/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 RANCH ROAD 3237
WIMBERLEY TX
78676-5311
US

IV. Provider business mailing address

1226 COUGAR DR
CANYON LAKE TX
78133-3374
US

V. Phone/Fax

Practice location:
  • Phone: 512-847-5540
  • Fax:
Mailing address:
  • Phone: 361-726-2678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number119970
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: