Individual
LESLEY KOLESA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
204 S KIMBERLIN ST, NONE, TROY, IL 62294-1614
(618) 505-0288
Mailing address
204 S KIMBERLIN ST, TROY, IL 62294-1614
(618) 505-0288
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057003774
IL
224Z00000X
Occupational Therapy Assistant
2013008064
MO
Other
Enumeration date
08/02/2013
Last updated
08/02/2013
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