Provider Demographics
NPI:1659805265
Name:LEACOCK, CHESLIE (MS OTR/L)
Entity Type:Individual
Prefix:
First Name:CHESLIE
Middle Name:
Last Name:LEACOCK
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 TEQUESTA DR
Mailing Address - Street 2:#24E
Mailing Address - City:TEQUESTA
Mailing Address - State:FL
Mailing Address - Zip Code:33469-2768
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:169 TEQUESTA DR
Practice Address - Street 2:#24E
Practice Address - City:TEQUESTA
Practice Address - State:FL
Practice Address - Zip Code:33469-2768
Practice Address - Country:US
Practice Address - Phone:561-747-8188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT17078225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics