Provider Demographics
NPI:1699559898
Name:DESROCHERS, LEO WILLIAM
Entity type:Individual
Prefix:
First Name:LEO
Middle Name:WILLIAM
Last Name:DESROCHERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 ROYAL CREST DR APT 12
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-6566
Mailing Address - Country:US
Mailing Address - Phone:802-535-9711
Mailing Address - Fax:
Practice Address - Street 1:47 ROYAL CREST DR APT 12
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-6566
Practice Address - Country:US
Practice Address - Phone:802-535-9711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2278E1000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedEducational