MEDICARE: LESLIE CAMPBELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Z00000X	Occupational Therapy Assistant	210467	TX

General Provider Information

NPI Number	:	1033476221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE CAMPBELL

Provider Business Mailing Address
First Line	:	925 S SEMORAN BLVD STE 108
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32792-5313
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12660 HILLCREST RD APT 2206
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-2026
Country	:	US
Telephone Number	:	254-747-3394
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2012
Last Update Date	:	04/12/2012

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Directions to “ LESLIE CAMPBELL ” Practice Location

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