Provider Demographics
NPI:1396581278
Name:MOON, LESLEE J (OTR/L)
Entity type:Individual
Prefix:
First Name:LESLEE
Middle Name:J
Last Name:MOON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:LESLEE
Other - Middle Name:J
Other - Last Name:MOON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:PO BOX 501
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:CO
Mailing Address - Zip Code:81226-0501
Mailing Address - Country:US
Mailing Address - Phone:719-251-3434
Mailing Address - Fax:
Practice Address - Street 1:903 MOORE DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:CO
Practice Address - Zip Code:81226-9509
Practice Address - Country:US
Practice Address - Phone:719-251-3434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0003539225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist