Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 107 | NC |
NPI | 1063421600 |
---|---|
Provider Name | Ms. Monika Louise Lesch |
First Address | Morganton, NC 28680-9044 |
Second Address | Morganton, NC 28655-3568 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
51744 | BLUE CROSS BLUE SHIELD (01) | NC |
7210191 | (05) | NC |