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General NPI Number Information
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NPI Number | 1790980290
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Entity Type | Individual
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Provider Name | LESLIE E PULLIAM OTR
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Gender | Female
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Dates
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Enumeration Date | 06/15/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4219 S WESTERN AVE
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City | OKLAHOMA CITY
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State | OK
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Zip | 73109-3410
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Country | US
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Telephone | 405-644-5289
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Fax |
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Provider Business Mailing Address
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Address Line | 9129 PEPPERDINE
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City | MIDWEST CITY
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State | OK
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Zip | 73130-6248
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Country | US
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Telephone | 405-455-5312
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Fax |
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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 | 225XN1300X
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Taxonomy Name | Neurorehabilitation Occupational Therapist
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License Number | 1100
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License Number State | OK
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