Provider Demographics
NPI:1679805238
Name:NEWLAND, LESLIE B (COTA/L)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:B
Last Name:NEWLAND
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2448 HOLTZ RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:OH
Mailing Address - Zip Code:44875-8810
Mailing Address - Country:US
Mailing Address - Phone:419-571-2736
Mailing Address - Fax:
Practice Address - Street 1:370 E HOWARD ST
Practice Address - Street 2:
Practice Address - City:WILLARD
Practice Address - State:OH
Practice Address - Zip Code:44890-1656
Practice Address - Country:US
Practice Address - Phone:419-935-0148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA 03898224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant