Healthcare Provider Details

I. General information

NPI: 1275088304
Provider Name (Legal Business Name): LESLEY HUTCHISON PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2016
Last Update Date: 08/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CARRIAGE PT SUITE 202
HURRICANE WV
25526-1526
US

IV. Provider business mailing address

2016 DUNLAP RIDGE RD
BUFFALO WV
25033-7471
US

V. Phone/Fax

Practice location:
  • Phone: 304-634-4085
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPTA 001497
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: