Provider Demographics
NPI:1063181550
Name:LESLINE, EMILY ANN (COTA)
Entity type:Individual
Prefix:MS
First Name:EMILY
Middle Name:ANN
Last Name:LESLINE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MRS
Other - First Name:EMILY
Other - Middle Name:ANN
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1417 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MCPHERSON
Mailing Address - State:KS
Mailing Address - Zip Code:67460-1901
Mailing Address - Country:US
Mailing Address - Phone:785-844-3173
Mailing Address - Fax:
Practice Address - Street 1:321 N CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:LINDSBORG
Practice Address - State:KS
Practice Address - Zip Code:67456-1904
Practice Address - Country:US
Practice Address - Phone:785-227-2334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS18-01277224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant