Provider Demographics
NPI:1811205594
Name:GOODSON, LESLIE R (OTR/L, CHT)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:R
Last Name:GOODSON
Suffix:
Gender:F
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:R
Other - Last Name:BORUCKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:351 N AIR DEPOT BLVD
Mailing Address - Street 2:STE X
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-1700
Mailing Address - Country:US
Mailing Address - Phone:405-732-1766
Mailing Address - Fax:405-732-4337
Practice Address - Street 1:351 N AIR DEPOT BLVD
Practice Address - Street 2:STE X
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-1700
Practice Address - Country:US
Practice Address - Phone:405-732-1766
Practice Address - Fax:405-732-4337
Is Sole Proprietor?:No
Enumeration Date:2010-09-16
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT11614225XH1200X
OKOT 467225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand