Provider Demographics
NPI:1912107533
Name:TRELA, LESA KAY (OTR)
Entity Type:Individual
Prefix:MRS
First Name:LESA
Middle Name:KAY
Last Name:TRELA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SISTERS OF PROVIDENCE
Mailing Address - Street 2:OCCUPATIONAL AND SPEECH THERAPY DEPT
Mailing Address - City:SAINT MARY OF THE WOODS
Mailing Address - State:IN
Mailing Address - Zip Code:47876-1007
Mailing Address - Country:US
Mailing Address - Phone:812-535-1095
Mailing Address - Fax:
Practice Address - Street 1:1 SISTERS OF PROVIDENCE
Practice Address - Street 2:OCCUPATIONAL AND SPEECH THERAPY DEPT
Practice Address - City:SAINT MARY OF THE WOODS
Practice Address - State:IN
Practice Address - Zip Code:47876-1007
Practice Address - Country:US
Practice Address - Phone:812-535-1095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-22
Last Update Date:2007-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31004104A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist