Provider Demographics
NPI:1558722462
Name:LAURYL LEKSRISAWAT LLC
Entity Type:Organization
Organization Name:LAURYL LEKSRISAWAT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURYL
Authorized Official - Middle Name:RAYE
Authorized Official - Last Name:MCCOY-LEKSRISAWAWT
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:502-296-9897
Mailing Address - Street 1:1924 DUKER AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-1002
Mailing Address - Country:US
Mailing Address - Phone:502-296-9897
Mailing Address - Fax:502-290-6017
Practice Address - Street 1:1924 DUKER AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-1002
Practice Address - Country:US
Practice Address - Phone:502-296-9897
Practice Address - Fax:502-290-6017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-19
Last Update Date:2016-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR2741225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty