Provider Demographics
NPI:1891201455
Name:HOUDE, LESLIE LYNN (OT)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:LYNN
Last Name:HOUDE
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 1:202 N WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:VA
Mailing Address - Zip Code:24301-5022
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8100 BETH NELSON DR
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:VA
Practice Address - Zip Code:24141-9000
Practice Address - Country:US
Practice Address - Phone:540-230-6479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-19
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119001539225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA54-6001433OtherPULASKI COUNTY PUBLIC SCHOOLS