MEDICARE: MICHELLE LENORE LESNICK

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	225XG0600X	Gerontology Occupational Therapist	OT19395	FL

General Provider Information

NPI Number	:	1184236242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE LENORE LESNICK

Provider Business Mailing Address
First Line	:	400 LESLIE DR APT 530
Second Line	:
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-2966
Country	:	US
Telephone Number	:	949-413-2062
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 LESLIE DR APT 530
Second Line	:
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-2966
Country	:	US
Telephone Number	:	949-413-2062
Fax Number	:

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

Provider Enumeration Date	:	08/20/2020
Last Update Date	:	08/20/2020

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