Provider Demographics
NPI:1326172578
Name:HATHAWAY, LESLIE BETH (OTD, MS, OTRL)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:BETH
Last Name:HATHAWAY
Suffix:
Gender:F
Credentials:OTD, MS, OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5209 NEUSE TAVERN CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-7889
Mailing Address - Country:US
Mailing Address - Phone:919-578-3285
Mailing Address - Fax:919-999-3483
Practice Address - Street 1:5209 NEUSE TAVERN CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-7889
Practice Address - Country:US
Practice Address - Phone:919-578-3285
Practice Address - Fax:919-999-3483
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4887225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC139COOtherBCBS