Provider Demographics
NPI:1245522770
Name:MOEHLE, LESLEY J (BS, LMT)
Entity type:Individual
Prefix:
First Name:LESLEY
Middle Name:J
Last Name:MOEHLE
Suffix:
Gender:F
Credentials:BS, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1002
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-0034
Mailing Address - Country:US
Mailing Address - Phone:541-301-7449
Mailing Address - Fax:
Practice Address - Street 1:268 VAN NESS AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1736
Practice Address - Country:US
Practice Address - Phone:541-301-7449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-02
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13277225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist