MEDICARE: AMY LESLIE OTR/L

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	225X00000X	Occupational Therapist	OT21332	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235731316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY LESLIE OTR/L

Provider Business Mailing Address
First Line	:	12529 GENTLE KNOLL CT
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32258-4120
Country	:	US
Telephone Number	:	904-868-9764
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 TAVERNIER DR STE B
Second Line	:
City	:	PONTE VEDRA
State	:	FL
Zip	:	32081-1270
Country	:	US
Telephone Number	:	904-404-2345
Fax Number	:	904-789-6295

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

Provider Enumeration Date	:	11/12/2020
Last Update Date	:	06/10/2025

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