Provider Demographics
NPI:1184499063
Name:GILLENSON, LESLIE EVE (OTR)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:EVE
Last Name:GILLENSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:EVE
Other - Last Name:MERVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3045 KATE BOND RD
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38133-4004
Mailing Address - Country:US
Mailing Address - Phone:901-937-3200
Mailing Address - Fax:901-725-8346
Practice Address - Street 1:3045 KATE BOND RD
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38133-4004
Practice Address - Country:US
Practice Address - Phone:901-937-3200
Practice Address - Fax:901-725-8346
Is Sole Proprietor?:No
Enumeration Date:2023-11-20
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1535225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand