Provider Demographics
NPI:1225017437
Name:RAKE, LESLIE J (OTR/L)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:J
Last Name:RAKE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9668 HORNE LN
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-6280
Mailing Address - Country:US
Mailing Address - Phone:239-495-1857
Mailing Address - Fax:
Practice Address - Street 1:3938 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-3622
Practice Address - Country:US
Practice Address - Phone:941-366-0011
Practice Address - Fax:941-957-0033
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 10592225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z098DOtherBLUE CROSS BLUE SHIELD FL
Z098DOtherBLUE CROSS BLUE SHIELD FL