Provider Demographics
NPI:1164970893
Name:ANDRADE, LESLIET (COTA/L)
Entity Type:Individual
Prefix:
First Name:LESLIET
Middle Name:
Last Name:ANDRADE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9340 MARINE DR
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-1845
Mailing Address - Country:US
Mailing Address - Phone:786-325-1652
Mailing Address - Fax:
Practice Address - Street 1:9340 MARINE DR
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-1845
Practice Address - Country:US
Practice Address - Phone:786-325-1652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-11
Last Update Date:2016-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA 15450224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant