Provider Demographics
NPI:1558879213
Name:LANGSBARD, LESLIE ANNE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:ANNE
Last Name:LANGSBARD
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:NA
Other - Middle Name:NA
Other - Last Name:VON ALVEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:4920 CANTERWOOD DR NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-8856
Mailing Address - Country:US
Mailing Address - Phone:262-758-1394
Mailing Address - Fax:
Practice Address - Street 1:630 S PEARL ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98465-2111
Practice Address - Country:US
Practice Address - Phone:253-671-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT60815786225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist