MEDICARE: LESLIE ANGELIE MARTINEZ

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	17848	NC

General Provider Information

NPI Number	:	1710816889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE ANGELIE MARTINEZ

Provider Business Mailing Address
First Line	:	1455 TYGRESS DR
Second Line	:
City	:	KANNAPOLIS
State	:	NC
Zip	:	28081-7165
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6001 WILORA LAKE RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28212-2833
Country	:	US
Telephone Number	:	704-563-2922
Fax Number	:

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

Provider Enumeration Date	:	05/15/2026
Last Update Date	:	05/15/2026

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Directions to “ LESLIE ANGELIE MARTINEZ ” Practice Location

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