Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XP0200X | Occupational Therapist - Pediatrics | 104538 | TX |
NPI | 1033129739 |
---|---|
Provider Name | Gina K Leslie-Strack |
First Address | Spicewood, TX 78669-0255 |
Second Address | Spicewood, TX 78669 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 03/08/2011 |