Provider Demographics
NPI:1629189600
Name:LEISZLER, THERESE (OT)
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:
Last Name:LEISZLER
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 1:636 9TH RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:KS
Mailing Address - Zip Code:66937-8829
Mailing Address - Country:US
Mailing Address - Phone:785-348-5404
Mailing Address - Fax:785-348-5334
Practice Address - Street 1:612 3RD ST
Practice Address - Street 2:
Practice Address - City:LINN
Practice Address - State:KS
Practice Address - Zip Code:66953-9052
Practice Address - Country:US
Practice Address - Phone:785-348-5334
Practice Address - Fax:785-348-5334
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-02187225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist