Provider Demographics
NPI:1801215223
Name:LIPTRAP, LESLIE K (COTA/L)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:K
Last Name:LIPTRAP
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11348 WYNDHAM CIR
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-9017
Mailing Address - Country:US
Mailing Address - Phone:614-581-3958
Mailing Address - Fax:
Practice Address - Street 1:7244 E MAIN ST
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-2014
Practice Address - Country:US
Practice Address - Phone:614-501-1020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-14
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA 00112171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor