Healthcare Provider Details

I. General information

NPI: 1669549036
Provider Name (Legal Business Name): LESLIE Y DOBKINS OCCUPATIONAL THERAPI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4515 SW COUNTRY CLUB DR
CORVALLIS OR
97333
US

IV. Provider business mailing address

4515 SW COUNTRY CLUB DR
CORVALLIS OR
97333
US

V. Phone/Fax

Practice location:
  • Phone: 541-757-8068
  • Fax: 541-758-1030
Mailing address:
  • Phone: 541-757-8068
  • Fax: 541-758-1030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number999231
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: