Provider Demographics
NPI:1114285616
Name:ORTON-MAHAR, LESLIE JANET (PTA)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:JANET
Last Name:ORTON-MAHAR
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 PINE COBBLE RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01267-2334
Mailing Address - Country:US
Mailing Address - Phone:413-458-3452
Mailing Address - Fax:
Practice Address - Street 1:495 PINE COBBLE RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:MA
Practice Address - Zip Code:01267-2334
Practice Address - Country:US
Practice Address - Phone:413-458-3452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-03
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8576225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant