Provider Demographics
NPI:1831862804
Name:SAMULAK, LESLEY (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:LESLEY
Middle Name:
Last Name:SAMULAK
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5775 NANNYBERRY CIR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-5169
Mailing Address - Country:US
Mailing Address - Phone:941-777-0527
Mailing Address - Fax:941-315-8546
Practice Address - Street 1:1850 RYE RD
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34212-9038
Practice Address - Country:US
Practice Address - Phone:941-777-0527
Practice Address - Fax:941-315-8546
Is Sole Proprietor?:No
Enumeration Date:2021-07-27
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist