MEDICARE: LESLIE LYNN LOONEY OTR/L

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	17-02712	KS
2	225X00000X	Occupational Therapist	3040	NM

General Provider Information

NPI Number	:	1538500525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE LYNN LOONEY OTR/L

Provider Business Mailing Address
First Line	:	5711 PERRYTON ST
Second Line	:
City	:	BEL AIRE
State	:	KS
Zip	:	67220-1911
Country	:	US
Telephone Number	:	316-990-2821
Fax Number	:

Provider Business Practice Location Address
First Line	:	1755 WITTINGTON PL
Second Line	:	SUITE 175
City	:	DALLAS
State	:	TX
Zip	:	75234-1927
Country	:	US
Telephone Number	:	214-442-4470
Fax Number	:

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

Provider Enumeration Date	:	07/08/2013
Last Update Date	:	07/08/2013

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