Provider Demographics
NPI:1275698805
Name:BAGANHA, LESLIE OLUVEIRA (OTRL CEIS)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:OLUVEIRA
Last Name:BAGANHA
Suffix:
Gender:F
Credentials:OTRL CEIS
Other - Prefix:MRS
Other - First Name:LESLIE
Other - Middle Name:OLIVEIRA
Other - Last Name:MELO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:20 WATER STREET
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02779
Mailing Address - Country:US
Mailing Address - Phone:508-823-8399
Mailing Address - Fax:
Practice Address - Street 1:1563 N MAIN STREET
Practice Address - Street 2:SUITE 208
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720
Practice Address - Country:US
Practice Address - Phone:508-324-1060
Practice Address - Fax:508-679-8590
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7751225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist