Provider Demographics
NPI:1841884327
Name:LESCALLEET, GARY ALLEN
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:ALLEN
Last Name:LESCALLEET
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:PO BOX 802
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:OH
Mailing Address - Zip Code:43080-0802
Mailing Address - Country:US
Mailing Address - Phone:740-249-3519
Mailing Address - Fax:
Practice Address - Street 1:566 N JEFFESON ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:OH
Practice Address - Zip Code:43080-4308
Practice Address - Country:US
Practice Address - Phone:740-249-3519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRT508297372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty