Provider Demographics
NPI:1477188233
Name:CORTESE, MONIQUE ANNE LESAGE
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:ANNE LESAGE
Last Name:CORTESE
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 1:4733 BUCIDA RD
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-7322
Mailing Address - Country:US
Mailing Address - Phone:561-369-3947
Mailing Address - Fax:
Practice Address - Street 1:2828 S SEACREST BLVD STE 204
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-7944
Practice Address - Country:US
Practice Address - Phone:561-734-9760
Practice Address - Fax:561-734-1595
Is Sole Proprietor?:No
Enumeration Date:2020-03-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2448225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist