Provider Demographics
NPI:1558424135
Name:ANDERSON, LESLIE A (OT)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:A
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451A CARLISLE DR
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4819
Mailing Address - Country:US
Mailing Address - Phone:703-481-3451
Mailing Address - Fax:703-481-1050
Practice Address - Street 1:451A CARLISLE DR
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4819
Practice Address - Country:US
Practice Address - Phone:703-481-3451
Practice Address - Fax:703-481-1050
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119004278174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist