Provider Demographics
NPI:1972109023
Name:NGUYEN, LESLIE THANH-BINH (OTR/L)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:THANH-BINH
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2156 TOWN SQUARE BLVD APT 436
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-9414
Mailing Address - Country:US
Mailing Address - Phone:832-301-8081
Mailing Address - Fax:
Practice Address - Street 1:2156 TOWN SQUARE BLVD APT 436
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-9414
Practice Address - Country:US
Practice Address - Phone:832-301-8081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121370225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist