Provider Demographics
NPI:1639708571
Name:LELAND, REBECCA BRADLEIGH (CO)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:BRADLEIGH
Last Name:LELAND
Suffix:
Gender:F
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2534 EMPIRE DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6710
Mailing Address - Country:US
Mailing Address - Phone:336-397-0993
Mailing Address - Fax:336-397-2167
Practice Address - Street 1:3250 HARDEN STREET EXT STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6842
Practice Address - Country:US
Practice Address - Phone:803-939-0097
Practice Address - Fax:803-939-1103
Is Sole Proprietor?:No
Enumeration Date:2020-04-03
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCCO006167222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist