Provider Demographics
NPI:1285158618
Name:HERBERT, LESLEY (MS OTR/L)
Entity type:Individual
Prefix:
First Name:LESLEY
Middle Name:
Last Name:HERBERT
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 EASTCHESTER RD APT 3A
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2187
Mailing Address - Country:US
Mailing Address - Phone:917-957-2594
Mailing Address - Fax:
Practice Address - Street 1:1925 EASTCHESTER RD APT 3A
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2187
Practice Address - Country:US
Practice Address - Phone:917-957-2594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021219225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist