Provider Demographics
NPI:1366450355
Name:LEBLANC, LINDA FAY (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:FAY
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 W 4TH ST
Mailing Address - Street 2:STE 110
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503
Mailing Address - Country:US
Mailing Address - Phone:775-786-8711
Mailing Address - Fax:775-786-8477
Practice Address - Street 1:1155 W 4TH ST
Practice Address - Street 2:STE 110
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503
Practice Address - Country:US
Practice Address - Phone:775-786-8711
Practice Address - Fax:775-786-8477
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV06702251H1200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
V38140Medicare ID - Type UnspecifiedNATIONAL