Individual
LESLIE C ERICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
3222 MISHAWAKA AVE, SOUTH BEND, IN 46615-2352
(574) 255-8730
Mailing address
524 E MCKINLEY AVE STE 1, MISHAWAKA, IN 46545-6285
(574) 255-8730
(574) 255-8732
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
31000509A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300032591
—
IN
Enumeration date
04/05/2010
Last updated
06/24/2024
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