Provider Demographics
NPI:1447472675
Name:MOY, LESLIE (OTR)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:
Last Name:MOY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 4TH ST
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:PA
Mailing Address - Zip Code:18052-5802
Mailing Address - Country:US
Mailing Address - Phone:610-351-0435
Mailing Address - Fax:
Practice Address - Street 1:4100 FREEMANSBURG AVE
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-5540
Practice Address - Country:US
Practice Address - Phone:610-330-9030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC005728L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist