MEDICARE: LESLEIGH B SISSON CFOM

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	225000000X	Orthotic Fitter

General Provider Information

NPI Number	:	1588851828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLEIGH B SISSON CFOM

Provider Business Mailing Address
First Line	:	400 SHADOW LN STE 110
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-4355
Country	:	US
Telephone Number	:	702-894-1410
Fax Number	:	702-384-0479

Provider Business Practice Location Address
First Line	:	2047 W CHARLESTON BLVD STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-2251
Country	:	US
Telephone Number	:	702-384-1410
Fax Number	:	702-384-0479

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

Provider Enumeration Date	:	10/01/2007
Last Update Date	:	04/10/2021

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Directions to “ LESLEIGH B SISSON CFOM” Practice Location

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