Provider Demographics
NPI:1528955424
Name:DESIRAE LEBLANC, OT LLC
Entity type:Organization
Organization Name:DESIRAE LEBLANC, OT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DESIRAE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:LEBLANC
Authorized Official - Suffix:
Authorized Official - Credentials:MSOT, OTR/L
Authorized Official - Phone:603-703-5164
Mailing Address - Street 1:486 METHODIST RD
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-3207
Mailing Address - Country:US
Mailing Address - Phone:603-703-5164
Mailing Address - Fax:
Practice Address - Street 1:486 METHODIST RD
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-3207
Practice Address - Country:US
Practice Address - Phone:603-703-5164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty