Provider Demographics
NPI:1033129739
Name:LESLIE-STRACK, GINA K (OTR, ATP)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:K
Last Name:LESLIE-STRACK
Suffix:
Gender:F
Credentials:OTR, ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 255
Mailing Address - Street 2:
Mailing Address - City:SPICEWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:78669-0255
Mailing Address - Country:US
Mailing Address - Phone:713-376-5752
Mailing Address - Fax:281-489-0927
Practice Address - Street 1:191 SPUR 191
Practice Address - Street 2:SUITE E
Practice Address - City:SPICEWOOD
Practice Address - State:TX
Practice Address - Zip Code:78669
Practice Address - Country:US
Practice Address - Phone:713-376-5752
Practice Address - Fax:281-489-0927
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104538225XP0200X
TXATP2727247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics