Provider Demographics
NPI:1912556275
Name:LEBLANC, DESIRAE ANNE (MSOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:DESIRAE
Middle Name:ANNE
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:MSOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 LEDGES DR
Mailing Address - Street 2:
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03246-2590
Mailing Address - Country:US
Mailing Address - Phone:603-527-8081
Mailing Address - Fax:603-527-8086
Practice Address - Street 1:21 LEDGES DR
Practice Address - Street 2:
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-2590
Practice Address - Country:US
Practice Address - Phone:603-527-8081
Practice Address - Fax:603-527-8086
Is Sole Proprietor?:No
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2929225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist