Provider Demographics
NPI:1922265180
Name:LITTLE, LESLIE (COTA)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:LITTLE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 FALULAH ST
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-8128
Mailing Address - Country:US
Mailing Address - Phone:978-302-5395
Mailing Address - Fax:
Practice Address - Street 1:40 CUMMINGS PARK
Practice Address - Street 2:SUITE 3950
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-2123
Practice Address - Country:US
Practice Address - Phone:791-933-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA221224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant