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General NPI Number Information
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NPI Number | 1861858987
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Entity Type | Individual
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Provider Name | LESLIE S COLEY CERTIFIED HAIR LOSS
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Gender | Female
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Dates
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Enumeration Date | 01/05/2016
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Last Update Date | 04/11/2019
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Provider Practice Location Address
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Address Line | 1484 GULF TO BAY BLVD UNIT 4
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City | CLEARWATER
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State | FL
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Zip | 33755
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Country | US
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Telephone | 813-530-6773
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Fax |
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Provider Business Mailing Address
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Address Line | 1484 GULF TO BAY BLVD UNIT 4
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City | CLEARWATER
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State | FL
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Zip | 33755
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Country | US
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Telephone | 813-530-6773
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1744P3200X
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Taxonomy Name | Prosthetics Case Management
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License Number | CL1181442
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License Number State | FL
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