Provider Demographics
NPI:1972665008
Name:WEAVER, LESLIE (OT)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:WEAVER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:
Other - Last Name:KRESEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1931 BLACK ROCK TPKE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-3506
Mailing Address - Country:US
Mailing Address - Phone:203-384-8681
Mailing Address - Fax:
Practice Address - Street 1:680 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-2684
Practice Address - Country:US
Practice Address - Phone:203-783-1997
Practice Address - Fax:203-783-3997
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000716225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist