Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OC014097 | PA |
NPI | 1003284530 |
---|---|
Provider Name | Jessica Leslie |
First Address | Pittsburgh, PA 15203-2054 |
Second Address | Pittsburgh, PA 15203-2054 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2015 |
Last Update Date | 15/09/2015 |