Provider Demographics
NPI:1922239599
Name:WHITAKER, LESLIE (COTA/L)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 PREAKNESS DR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27527-6284
Mailing Address - Country:US
Mailing Address - Phone:919-634-7690
Mailing Address - Fax:919-550-9628
Practice Address - Street 1:111 PREAKNESS DR
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27527-6284
Practice Address - Country:US
Practice Address - Phone:919-634-7690
Practice Address - Fax:919-550-9628
Is Sole Proprietor?:No
Enumeration Date:2009-07-30
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2364224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant