Individual
GABRIELLE LEISTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
710 JULIAN RD, SALISBURY, NC 28147-9079
(704) 636-5812
Mailing address
11411 WINNERS CIR, CHARLOTTE, NC 28215-6088
(717) 513-6959
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
10223
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10223
NC OTA LICENSE
NC
Enumeration date
11/08/2016
Last updated
04/04/2020
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