Individual
LESLIE MARIE GUGLIELMELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
1000 JOHNNIE DODDS BLVD STE 103-213, MOUNT PLEASANT, SC 29464-3135
(843) 425-2828
(843) 388-6346
Mailing address
1000 JOHNNIE DODDS BLVD STE 103-213, MOUNT PLEASANT, SC 29464-3135
(843) 425-2828
(843) 388-6346
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2647
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
97530
BLUE CROSS BLUE SHIELD
SC
05
—
GP4166
—
SC
05
—
TH1290
—
SC
Enumeration date
04/23/2007
Last updated
06/04/2012
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