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General NPI Number Information
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NPI Number | 1891201455
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Entity Type | Individual
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Provider Name | LESLIE LYNN HOUDE OT
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Gender | Female
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Dates
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Enumeration Date | 12/19/2017
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Last Update Date | 12/19/2017
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Provider Practice Location Address
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Address Line | 8100 BETH NELSON DR
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City | FAIRLAWN
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State | VA
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Zip | 24141-9000
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Country | US
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Telephone | 540-230-6479
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Fax |
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Provider Business Mailing Address
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Address Line | 202 N WASHINGTON AVE
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City | PULASKI
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State | VA
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Zip | 24301-5022
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Country | US
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Telephone |
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 0119001539
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License Number State | VA
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