Provider Demographics
NPI:1265919419
Name:COLLINS, LESLIE (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:
Other - Last Name:MILAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12701 WEST AVE APT 712
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-1863
Mailing Address - Country:US
Mailing Address - Phone:501-428-8204
Mailing Address - Fax:
Practice Address - Street 1:5034 NEWFOREST DR APT 8309
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-5468
Practice Address - Country:US
Practice Address - Phone:832-274-5911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-20
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A1382224Z00000X
TX216131224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR228808721Medicaid