Provider Demographics
NPI:1851509988
Name:JENKINS, LESA (OTL, CHT)
Entity Type:Individual
Prefix:
First Name:LESA
Middle Name:
Last Name:JENKINS
Suffix:
Gender:F
Credentials:OTL, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1894 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-7830
Mailing Address - Country:US
Mailing Address - Phone:330-699-8931
Mailing Address - Fax:
Practice Address - Street 1:6200 WHIPPLE AVE NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-7624
Practice Address - Country:US
Practice Address - Phone:330-966-8920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1034225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand