Individual
LESLIE LANCASTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
678 E LAKE DR, EDWARDSVILLE, IL 62025-4259
(618) 558-5715
Mailing address
678 E LAKE DR, EDWARDSVILLE, IL 62025-4259
(618) 558-5715
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057003844
IL
Other
Enumeration date
04/25/2016
Last updated
04/25/2016
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