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General NPI Number Information
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NPI Number | 1932408135
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Entity Type | Individual
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Provider Name | TAMARA ELIZABETH LEISEY OTR/L
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Gender | Female
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Dates
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Enumeration Date | 03/28/2011
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Last Update Date | 03/28/2011
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Provider Practice Location Address
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Address Line | 22 SW 258TH ST
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City | NEWBERRY
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State | FL
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Zip | 32669-4133
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Country | US
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Telephone | 352-474-6111
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Fax | 352-474-6112
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Provider Business Mailing Address
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Address Line | PO BOX 700
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City | CHIEFLAND
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State | FL
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Zip | 32644-0700
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Country | US
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Telephone | 352-490-7500
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Fax | 352-490-7110
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA26936
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT14482
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License Number State | FL
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