Healthcare Provider Details

I. General information

NPI: 1033583240
Provider Name (Legal Business Name): LESLIE ANN HARVELL OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LESLIE ANN HOLLAWAY

II. Dates (important events)

Enumeration Date: 11/25/2015
Last Update Date: 06/16/2021
Certification Date: 06/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8040 E MILL PLAIN BLVD
VANCOUVER WA
98664-2002
US

IV. Provider business mailing address

PO BOX 4825
PORTLAND OR
97208-4825
US

V. Phone/Fax

Practice location:
  • Phone: 360-882-2778
  • Fax:
Mailing address:
  • Phone: 360-882-2778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number15745
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number346828
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT60794368
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: