Provider Demographics
NPI:1851034375
Name:MICHAUD, LESLI (COTA)
Entity Type:Individual
Prefix:
First Name:LESLI
Middle Name:
Last Name:MICHAUD
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2022 ADAMS ST APT 202
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-6938
Mailing Address - Country:US
Mailing Address - Phone:786-863-1110
Mailing Address - Fax:
Practice Address - Street 1:2022 ADAMS ST APT 202
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-6938
Practice Address - Country:US
Practice Address - Phone:786-863-1110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA18678224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant