Provider Demographics
NPI:1710037890
Name:HILTZ, LESLIE RODRIGUEZ (OTL)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:RODRIGUEZ
Last Name:HILTZ
Suffix:
Gender:F
Credentials:OTL
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:CHRISTINA
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ORT L
Mailing Address - Street 1:6508 GUNN HIGHWAY
Mailing Address - Street 2:INDEPENDENT LIVING INC
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-4022
Mailing Address - Country:US
Mailing Address - Phone:813-963-6923
Mailing Address - Fax:813-264-0768
Practice Address - Street 1:6508 GUNN HIGHWAY
Practice Address - Street 2:INDEPENDENT LIVING INC
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-4022
Practice Address - Country:US
Practice Address - Phone:813-963-6923
Practice Address - Fax:813-264-0768
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 9116225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11210001OtherCITRUS HMO
FLZ077FOtherBCBS
FL356836OtherWELLCARE HMO