MEDICARE: DR. LESLIE M BUSHONG OTRL, OTD

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	225X00000X	Occupational Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OT11891	OTHER	FL	STATE LIC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518184159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LESLIE M BUSHONG OTRL, OTD

Provider Business Mailing Address
First Line	:	2221 W 45TH AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211-1526
Country	:	US
Telephone Number	:	303-653-8461
Fax Number	:

Provider Business Practice Location Address
First Line	:	2918 UMATILLA ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211-3833
Country	:	US
Telephone Number	:	859-630-0083
Fax Number	:

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

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	07/21/2022

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