Provider Demographics
NPI:1740002260
Name:MAYES, LESLIE R
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:R
Last Name:MAYES
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 1:4676 BELVEDERE CIR
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32571-1173
Mailing Address - Country:US
Mailing Address - Phone:205-260-4741
Mailing Address - Fax:
Practice Address - Street 1:4676 BELVEDERE CIR
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32571-1173
Practice Address - Country:US
Practice Address - Phone:205-260-4741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-28
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist