Provider Demographics
NPI:1942586102
Name:OTTEN, LESLEY KURAS (PHD)
Entity Type:Individual
Prefix:DR
First Name:LESLEY
Middle Name:KURAS
Last Name:OTTEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4421 EASTGATE BLVD
Mailing Address - Street 2:#300
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45245-4500
Mailing Address - Country:US
Mailing Address - Phone:513-752-8200
Mailing Address - Fax:513-752-1078
Practice Address - Street 1:4421 EASTGATE BLVD
Practice Address - Street 2:#300
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-4500
Practice Address - Country:US
Practice Address - Phone:513-752-8200
Practice Address - Fax:513-752-1078
Is Sole Proprietor?:No
Enumeration Date:2011-11-01
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH6847103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0124434Medicaid