Provider Demographics
NPI:1851531917
Name:DYE, LESLIE GAIL (OTA)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:GAIL
Last Name:DYE
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:TX
Mailing Address - Zip Code:76266-4203
Mailing Address - Country:US
Mailing Address - Phone:940-453-6218
Mailing Address - Fax:
Practice Address - Street 1:901 SEVEN OAKS RD
Practice Address - Street 2:
Practice Address - City:BONHAM
Practice Address - State:TX
Practice Address - Zip Code:75418-3237
Practice Address - Country:US
Practice Address - Phone:903-583-2191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-03
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208132224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant