Provider Demographics
NPI:1841487410
Name:SKILLMAN, LESLIE C (OT)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:C
Last Name:SKILLMAN
Suffix:
Gender:F
Credentials:OT
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 153068
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75015-3068
Mailing Address - Country:US
Mailing Address - Phone:972-659-1234
Mailing Address - Fax:972-827-0195
Practice Address - Street 1:2001 W AIRPORT FWY
Practice Address - Street 2:SUITE 105
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-6006
Practice Address - Country:US
Practice Address - Phone:972-659-1235
Practice Address - Fax:972-257-9748
Is Sole Proprietor?:No
Enumeration Date:2007-09-27
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105858225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist