Provider Demographics
NPI:1366650129
Name:BENNETT, LESLIE ELAINE (MS, OTR-L, CKTP)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:ELAINE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MS, OTR-L, CKTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5046A DOORSTONE DR
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-3712
Mailing Address - Country:US
Mailing Address - Phone:518-608-5092
Mailing Address - Fax:
Practice Address - Street 1:421 COLUMBIA ST
Practice Address - Street 2:EDDY COHOES REHABILITATION CENTER
Practice Address - City:COHOES
Practice Address - State:NY
Practice Address - Zip Code:12047-2217
Practice Address - Country:US
Practice Address - Phone:518-238-4076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013411-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist