Provider Demographics
NPI:1407495047
Name:HALBISEN, LESLIE (COTA/L)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:HALBISEN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 GLENVIEW DR
Mailing Address - Street 2:
Mailing Address - City:FOSTORIA
Mailing Address - State:OH
Mailing Address - Zip Code:44830-1624
Mailing Address - Country:US
Mailing Address - Phone:419-619-1069
Mailing Address - Fax:
Practice Address - Street 1:516 GLENVIEW DR
Practice Address - Street 2:
Practice Address - City:FOSTORIA
Practice Address - State:OH
Practice Address - Zip Code:44830-1624
Practice Address - Country:US
Practice Address - Phone:419-619-1069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-30
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant