Provider Demographics
NPI:1467743377
Name:FORSYTH, LESLIE ANN (OTR)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:ANN
Last Name:FORSYTH
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 1:1713 E 15TH ST
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-6436
Mailing Address - Country:US
Mailing Address - Phone:972-633-0888
Mailing Address - Fax:972-633-3888
Practice Address - Street 1:4700 ALLIANCE BLVD. SUITE 450
Practice Address - Street 2:BAYLOR INSTITUTE FOR REHAB
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093
Practice Address - Country:US
Practice Address - Phone:469-814-2561
Practice Address - Fax:469-814-2569
Is Sole Proprietor?:No
Enumeration Date:2011-04-26
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101772225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist