Provider Demographics
NPI:1417135807
Name:LESLIE, MONICA MARTHA (OTR)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:MARTHA
Last Name:LESLIE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43575 COUNTY HIGHWAY 35
Mailing Address - Street 2:
Mailing Address - City:DENT
Mailing Address - State:MN
Mailing Address - Zip Code:56528-9137
Mailing Address - Country:US
Mailing Address - Phone:218-758-2415
Mailing Address - Fax:
Practice Address - Street 1:211 EAST MILL STREET
Practice Address - Street 2:
Practice Address - City:PELICAN RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56572
Practice Address - Country:US
Practice Address - Phone:218-758-2415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN102020225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist