Provider Demographics
NPI:1992098040
Name:SHUGHART, LESLIE ANN (OTA/L)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:ANN
Last Name:SHUGHART
Suffix:
Gender:F
Credentials:OTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 BIG SPRING RD
Mailing Address - Street 2:
Mailing Address - City:NEWVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17241-9497
Mailing Address - Country:US
Mailing Address - Phone:717-776-8255
Mailing Address - Fax:717-776-3040
Practice Address - Street 1:210 BIG SPRING RD
Practice Address - Street 2:
Practice Address - City:NEWVILLE
Practice Address - State:PA
Practice Address - Zip Code:17241-9497
Practice Address - Country:US
Practice Address - Phone:717-776-8255
Practice Address - Fax:717-776-3040
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP006272224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant