Provider Demographics
NPI:1831722537
Name:LEFFUE, KELSIE RAE (COTA/L)
Entity type:Individual
Prefix:
First Name:KELSIE
Middle Name:RAE
Last Name:LEFFUE
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 1:5221 KNIGHTSBRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-8434
Mailing Address - Country:US
Mailing Address - Phone:540-493-3208
Mailing Address - Fax:
Practice Address - Street 1:2701 PICKETT RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-5688
Practice Address - Country:US
Practice Address - Phone:919-419-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131001375224Z00000X
NC13020224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant