Healthcare Provider Details

I. General information

NPI: 1255257853
Provider Name (Legal Business Name): LESLEY THAO
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 HAZEL ST
OSHKOSH WI
54901-4600
US

IV. Provider business mailing address

631 HAZEL ST
OSHKOSH WI
54901-4600
US

V. Phone/Fax

Practice location:
  • Phone: 920-252-4442
  • Fax: 920-252-4460
Mailing address:
  • Phone: 920-252-4442
  • Fax: 920-252-4460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: