Gavin, Leslie
Gavin, Leslie is an sole proprietor health care provider with primary practice located at 1000 Saint Louis Ave Suite 102, Fort Worth TX 76104-3366. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Occupational Therapist, which is considered as her primary health care specialty. Gavin, Leslie can be contacted via phone (817) 921-5020.Contact Information
Primary practice address
1000 Saint Louis Ave Suite 102
Fort Worth TX 76104-3366
Phone: (817) 921-5020
Fax: (817) 789-6849
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Occupational Therapist | 225X00000X | 305161 | Texas |
Profile Details
| NPI number | 1659618445 |
|---|---|
| LBN Legal business name | Gavin, Leslie |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jan 14th, 2013 |
| Last updated | Nov 12th, 2020 - about 6 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1659618445 | NPPES |
| Texas | MEDICAID | 149984001 | |
| Texas | MEDICAID | 207164901 |
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