Provider Demographics
NPI:1720296700
Name:HARVEY, LESLIE DARA (COTA)
Entity Type:Individual
Prefix:MISS
First Name:LESLIE
Middle Name:DARA
Last Name:HARVEY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 BRIARVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-2165
Mailing Address - Country:US
Mailing Address - Phone:864-561-3748
Mailing Address - Fax:
Practice Address - Street 1:1941 SAVAGE RD STE 400C
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4791
Practice Address - Country:US
Practice Address - Phone:866-571-2700
Practice Address - Fax:877-571-2124
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
SC2679224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant