Provider Demographics
NPI:1982759353
Name:SWICORD, LESLIE BAGGETT
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:BAGGETT
Last Name:SWICORD
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 1:3044 CHEROKEE TRL
Mailing Address - Street 2:
Mailing Address - City:TALLASSEE
Mailing Address - State:AL
Mailing Address - Zip Code:36078-3739
Mailing Address - Country:US
Mailing Address - Phone:334-283-8871
Mailing Address - Fax:
Practice Address - Street 1:3044 CHEROKEE TRL
Practice Address - Street 2:
Practice Address - City:TALLASSEE
Practice Address - State:AL
Practice Address - Zip Code:36078-3739
Practice Address - Country:US
Practice Address - Phone:334-283-8871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2109225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist