Provider Demographics
NPI:1083035422
Name:LODEN, LESLEE S (OTR/L)
Entity type:Individual
Prefix:
First Name:LESLEE
Middle Name:S
Last Name:LODEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:LODEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:2534 ATTALA ROAD 2247
Mailing Address - Street 2:
Mailing Address - City:KOSCIUSKO
Mailing Address - State:MS
Mailing Address - Zip Code:39090-4851
Mailing Address - Country:US
Mailing Address - Phone:662-834-5166
Mailing Address - Fax:662-834-5317
Practice Address - Street 1:239 BOWLING GREEN RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MS
Practice Address - Zip Code:39095-5167
Practice Address - Country:US
Practice Address - Phone:662-834-5166
Practice Address - Fax:662-834-5317
Is Sole Proprietor?:No
Enumeration Date:2014-01-03
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT 1540225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist