Provider Demographics
NPI:1427570035
Name:BARDIN, LESLIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:BARDIN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 SPRUCE KNOB RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN SPRINGS
Mailing Address - State:VT
Mailing Address - Zip Code:05757-4442
Mailing Address - Country:US
Mailing Address - Phone:802-235-2264
Mailing Address - Fax:
Practice Address - Street 1:9 HAYWOOD AVE
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4832
Practice Address - Country:US
Practice Address - Phone:802-775-0007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-14
Last Update Date:2017-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist