=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982759353
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LESLIE BAGGETT SWICORD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3044 CHEROKEE TRL
-----------------------------------------------------
City | TALLASSEE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36078-3739
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-283-8871
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3044 CHEROKEE TRL
-----------------------------------------------------
City | TALLASSEE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36078-3739
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-283-8871
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 2109
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------