Provider Demographics
NPI:1316332760
Name:KENNEDY, LESLIE JEAN (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:JEAN
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 W MAIN ST
Mailing Address - Street 2:ATTN: REHABCARE
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-4222
Mailing Address - Country:US
Mailing Address - Phone:540-381-1742
Mailing Address - Fax:540-381-1742
Practice Address - Street 1:1140 W MAIN ST
Practice Address - Street 2:ATTN: REHABCARE
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-4222
Practice Address - Country:US
Practice Address - Phone:540-381-1742
Practice Address - Fax:540-381-1742
Is Sole Proprietor?:No
Enumeration Date:2015-04-02
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119006441225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist