Provider Demographics
NPI:1801921531
Name:WOLFF, LESLIE KAY (OTR L)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:KAY
Last Name:WOLFF
Suffix:
Gender:F
Credentials:OTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1339 COMMERCE AVE
Mailing Address - Street 2:SUITE 314
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-3738
Mailing Address - Country:US
Mailing Address - Phone:360-560-1972
Mailing Address - Fax:360-703-3452
Practice Address - Street 1:1339 COMMERCE AVE
Practice Address - Street 2:SUITE 314
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-3738
Practice Address - Country:US
Practice Address - Phone:360-560-1972
Practice Address - Fax:360-703-3452
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00001294225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7018088Medicaid