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General NPI Number Information
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NPI Number | 1083035422
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Entity Type | Individual
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Provider Name | LESLEE S LODEN OTR/L
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Gender | Female
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Dates
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Enumeration Date | 01/03/2014
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Last Update Date | 01/03/2014
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Provider Practice Location Address
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Address Line | 239 BOWLING GREEN RD
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City | LEXINGTON
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State | MS
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Zip | 39095-5167
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Country | US
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Telephone | 662-834-5166
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Fax | 662-834-5317
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Provider Business Mailing Address
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Address Line | 2534 ATTALA ROAD 2247
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City | KOSCIUSKO
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State | MS
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Zip | 39090-4851
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Country | US
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Telephone | 662-834-5166
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Fax | 662-834-5317
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT 1540
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License Number State | MS
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