Provider Demographics
NPI:1710259973
Name:TAYLOR, LESLIE (OTR)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:BACCUS
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:PO BOX 1379
Mailing Address - Street 2:
Mailing Address - City:PUUNENE
Mailing Address - State:HI
Mailing Address - Zip Code:96784-1379
Mailing Address - Country:US
Mailing Address - Phone:808-873-7700
Mailing Address - Fax:808-873-7711
Practice Address - Street 1:426 TARROW ST
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77840-7814
Practice Address - Country:US
Practice Address - Phone:979-777-0617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1134225X00000X, 225XP0019X, 225XP0200X
TX77196101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics