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General NPI Number Information
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NPI Number | 1174651384
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Entity Type | Individual
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Provider Name | LESLIE ANN CAPETILLO O.T.
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Gender | Male
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1717 W 10TH ST
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City | AUSTIN
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State | TX
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Zip | 78703-3907
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Country | US
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Telephone | 512-804-3100
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Fax | 512-472-3103
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Provider Business Mailing Address
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Address Line | 1430 COLLIER ST
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City | AUSTIN
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State | TX
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Zip | 78704-2911
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Country | US
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Telephone | 512-445-7787
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Fax | 512-440-4059
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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 | 110773
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License Number State | TX
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