Provider Demographics
NPI:1114586468
Name:BARUCH, LESLIE D (OT)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:D
Last Name:BARUCH
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:RITA
Other - Last Name:DERWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:515 RAY C HUNT DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-2981
Practice Address - Country:US
Practice Address - Phone:434-244-2000
Practice Address - Fax:434-244-2001
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119000079225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist