Provider Demographics
NPI:1821250614
Name:BRAY-LAUTENSCHLAGER, LESLEY LYNN (MS, OT)
Entity Type:Individual
Prefix:MRS
First Name:LESLEY
Middle Name:LYNN
Last Name:BRAY-LAUTENSCHLAGER
Suffix:
Gender:F
Credentials:MS, OT
Other - Prefix:MRS
Other - First Name:LESLEY
Other - Middle Name:LYNN
Other - Last Name:BRAY-LAUTENSCHLAGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, OT
Mailing Address - Street 1:1550 RAYMOND ST
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-2060
Mailing Address - Country:US
Mailing Address - Phone:317-838-8916
Mailing Address - Fax:
Practice Address - Street 1:1550 RAYMOND ST
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-2060
Practice Address - Country:US
Practice Address - Phone:317-838-8916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31000290A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist