Provider Demographics
NPI:1235003609
Name:BIRBICK, LESLEY CLAIRE
Entity type:Individual
Prefix:
First Name:LESLEY
Middle Name:CLAIRE
Last Name:BIRBICK
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 1:661 NAOMI AVE
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-8350
Mailing Address - Country:US
Mailing Address - Phone:336-339-1224
Mailing Address - Fax:
Practice Address - Street 1:661 NAOMI AVE
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-8350
Practice Address - Country:US
Practice Address - Phone:336-339-1224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-30
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13562224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty