Provider Demographics
NPI:1417489436
Name:MCGLIN, LESLIE (COTA)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:MCGLIN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 E CALUMET ST
Mailing Address - Street 2:APT 1
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915-4249
Mailing Address - Country:US
Mailing Address - Phone:715-582-0144
Mailing Address - Fax:
Practice Address - Street 1:701 WILLOW ST
Practice Address - Street 2:
Practice Address - City:PESHTIGO
Practice Address - State:WI
Practice Address - Zip Code:54157-1165
Practice Address - Country:US
Practice Address - Phone:715-582-0144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5357224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant