Provider Demographics
NPI:1811228620
Name:MILLER, LESLIE (OT)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:MILLER
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 1:2656 S LOOP W
Mailing Address - Street 2:200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2664
Mailing Address - Country:US
Mailing Address - Phone:817-274-1200
Mailing Address - Fax:817-274-1299
Practice Address - Street 1:2656 S LOOP W
Practice Address - Street 2:200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2664
Practice Address - Country:US
Practice Address - Phone:817-274-1200
Practice Address - Fax:817-274-1299
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-18
Last Update Date:2010-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107337225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist