Provider Demographics
NPI:1023084738
Name:BOONE, LESLIE A (OTR/ CHT)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:A
Last Name:BOONE
Suffix:
Gender:F
Credentials:OTR/ CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 9095
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96538
Mailing Address - Country:UM
Mailing Address - Phone:501-944-9009
Mailing Address - Fax:
Practice Address - Street 1:BOX 9095
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96538
Practice Address - Country:UM
Practice Address - Phone:501-944-9009
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005213225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand