Provider Demographics
NPI:1518184159
Name:BUSHONG, LESLIE M (OTRL, OTD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:M
Last Name:BUSHONG
Suffix:
Gender:F
Credentials:OTRL, OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2221 W 45TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-1526
Mailing Address - Country:US
Mailing Address - Phone:303-653-8461
Mailing Address - Fax:
Practice Address - Street 1:2918 UMATILLA ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-3833
Practice Address - Country:US
Practice Address - Phone:859-630-0083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOT11891OtherSTATE LIC
FL892106700Medicaid