Provider Demographics
NPI:1710517578
Name:HUTCHERSON, LESLIE H
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:H
Last Name:HUTCHERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6061 SHOWELL CIR
Mailing Address - Street 2:
Mailing Address - City:PFAFFTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27040-9829
Mailing Address - Country:US
Mailing Address - Phone:336-493-5740
Mailing Address - Fax:
Practice Address - Street 1:2560 WILLARD RD # 5740
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27107-5543
Practice Address - Country:US
Practice Address - Phone:336-493-5740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-21
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7928224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant