Healthcare Provider Details

I. General information

NPI: 1447472675
Provider Name (Legal Business Name): LESLIE MOY OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 FREEMANSBURG AVE
EASTON PA
18045-5540
US

IV. Provider business mailing address

714 4TH ST
WHITEHALL PA
18052-5802
US

V. Phone/Fax

Practice location:
  • Phone: 610-330-9030
  • Fax:
Mailing address:
  • Phone: 610-351-0435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC005728L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: