Provider Demographics
NPI:1275673261
Name:BEAUCHAMP, LESA LEA (OTRL)
Entity Type:Individual
Prefix:MS
First Name:LESA
Middle Name:LEA
Last Name:BEAUCHAMP
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12507 ROLLING HILLS CIR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67235-1319
Mailing Address - Country:US
Mailing Address - Phone:316-619-4099
Mailing Address - Fax:
Practice Address - Street 1:854 N. SOCORA
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212
Practice Address - Country:US
Practice Address - Phone:316-729-6623
Practice Address - Fax:316-729-0021
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-00621225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand