Healthcare Provider Details

I. General information

NPI: 1003238809
Provider Name (Legal Business Name): LESLIE PRICE OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2014
Last Update Date: 01/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 COORS BLVD NW STE 100
ALBUQUERQUE NM
87120-1173
US

IV. Provider business mailing address

2929 COORS BLVD NW STE 100
ALBUQUERQUE NM
87120-1173
US

V. Phone/Fax

Practice location:
  • Phone: 505-836-4899
  • Fax: 505-836-4844
Mailing address:
  • Phone: 505-836-4899
  • Fax: 505-836-4844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2983
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: