Individual
MISS LESLIE ANNE WHITE MOON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
9200 W STARK ST, PORTLAND, OR 97229-6516
(503) 943-9498
Mailing address
9200 W STARK ST, PORTLAND, OR 97229-6516
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
505083
OR
Other
Enumeration date
03/05/2024
Last updated
03/05/2024
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