Provider Demographics
NPI:1215156682
Name:OLMSTEAD, LESLIE NICOLE (OTR)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:NICOLE
Last Name:OLMSTEAD
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:NICOLE
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1722 AGNES DR
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-2759
Mailing Address - Country:US
Mailing Address - Phone:785-650-0422
Mailing Address - Fax:
Practice Address - Street 1:315 S ASH ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:KS
Practice Address - Zip Code:67669-2136
Practice Address - Country:US
Practice Address - Phone:785-425-6754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1701635225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist