Basic Information
| Provider Information | |||||||||
| NPI: | 1508364357 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLARE | ||||||||
| FirstName: | LESLEY | ||||||||
| MiddleName: | ANN | ||||||||
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| NameSuffix: | X | ||||||||
| Credential: | COTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 SYCAMORE DR | ||||||||
| Address2: | |||||||||
| City: | WEST GROVE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193908818 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 SYCAMORE DR | ||||||||
| Address2: | |||||||||
| City: | WEST GROVE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193908818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108696768 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2018 | ||||||||
| LastUpdateDate: | 01/26/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | OP008537 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.