Provider Demographics
NPI:1669432506
Name:SCHROEDER, LESLIE A (PT)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:A
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:LESLIE
Other - Middle Name:A
Other - Last Name:SHIPPY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:10001 S WESTERN AVE
Mailing Address - Street 2:204
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-2997
Mailing Address - Country:US
Mailing Address - Phone:405-691-5434
Mailing Address - Fax:405-692-3403
Practice Address - Street 1:10001 S WESTERN AVE
Practice Address - Street 2:204
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-2997
Practice Address - Country:US
Practice Address - Phone:405-691-5434
Practice Address - Fax:405-692-3403
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1051225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP00472000OtherRR MEDICARE
OK200281230AMedicaid
OK370203Medicare Oscar/Certification
OKP00472000OtherRR MEDICARE
OK245603701Medicare PIN