Provider Demographics
NPI:1255330601
Name:HARDIN, LESLIE A (OT)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:A
Last Name:HARDIN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MRS
Other - First Name:LESLIE
Other - Middle Name:A
Other - Last Name:BLAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:2431 S LOOP 289
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-1519
Mailing Address - Country:US
Mailing Address - Phone:806-771-8008
Mailing Address - Fax:806-771-8009
Practice Address - Street 1:2431 S LOOP 289
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-1519
Practice Address - Country:US
Practice Address - Phone:806-771-8008
Practice Address - Fax:806-771-8009
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105722225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX218998701Medicaid
TX146593100OtherFIRSTCARE
TX8T4357OtherBLUE CROSS BLUE SHIELD
TXP00304752OtherMEDICARE RAILROAD
TX8D7314Medicare PIN