Basic Information
| Provider Information | |||||||||
| NPI: | 1922244714 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PERRY | ||||||||
| FirstName: | LESLIE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | OTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2111 MERRITT RD | ||||||||
| Address2: | SUITE 216 | ||||||||
| City: | EAST LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488236916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173323232 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2900 HANNAH BLVD | ||||||||
| Address2: | SUITE 216 | ||||||||
| City: | EAST LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488235384 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173648001 | ||||||||
| FaxNumber: | 5173648002 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2008 | ||||||||
| LastUpdateDate: | 06/09/2016 | ||||||||
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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 | 225X00000X | 5201004593 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.