Provider Demographics
NPI:1174900344
Name:KEISTER, LESLIE A (OTR, MOT)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:A
Last Name:KEISTER
Suffix:
Gender:F
Credentials:OTR, MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8416 E CRAIG DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67210-1727
Mailing Address - Country:US
Mailing Address - Phone:325-829-6151
Mailing Address - Fax:
Practice Address - Street 1:3636 N RIDGE RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-1213
Practice Address - Country:US
Practice Address - Phone:316-462-3636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-27
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-03014225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist