Provider Demographics
NPI:1811152093
Name:LAND, LEKESHA RENEE (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:LEKESHA
Middle Name:RENEE
Last Name:LAND
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 1:426 WEDGEWOOD ARMS
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5956
Mailing Address - Country:US
Mailing Address - Phone:252-258-1142
Mailing Address - Fax:
Practice Address - Street 1:1075 US HIGHWAY 17 S
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-7628
Practice Address - Country:US
Practice Address - Phone:252-338-3975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-27
Last Update Date:2008-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6809224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant