MEDICARE: LESLIE CABALLERO OTA/S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1093662082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE CABALLERO OTA/S

Provider Business Mailing Address
First Line	:	1440 ROCK CREEK FORD RD NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20011-1701
Country	:	US
Telephone Number	:	202-594-0665
Fax Number	:

Provider Business Practice Location Address
First Line	:	20500 SENECA MEADOWS PKWY
Second Line	:
City	:	GERMANTOWN
State	:	MD
Zip	:	20876-7008
Country	:	US
Telephone Number	:	301-916-8500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2026
Last Update Date	:	03/11/2026

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