Provider Demographics
NPI:1952608747
Name:SMITH, LESLIE A (OT)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:A
Last Name:SMITH
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 1:3000 NORTHWOODS PKWY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30071-4708
Mailing Address - Country:US
Mailing Address - Phone:866-518-1750
Mailing Address - Fax:866-600-4001
Practice Address - Street 1:3000 NORTHWOODS PKWY
Practice Address - Street 2:SUITE 105
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-4708
Practice Address - Country:US
Practice Address - Phone:866-518-1750
Practice Address - Fax:866-600-4001
Is Sole Proprietor?:No
Enumeration Date:2011-02-15
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109747225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist