Provider Demographics
NPI:1548953995
Name:WANDLER, LESLEY MAGNER (LOTR)
Entity type:Individual
Prefix:MRS
First Name:LESLEY
Middle Name:MAGNER
Last Name:WANDLER
Suffix:
Gender:F
Credentials:LOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 MAGNOLIA LN
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-1646
Mailing Address - Country:US
Mailing Address - Phone:985-264-9828
Mailing Address - Fax:
Practice Address - Street 1:429 MAGNOLIA LN
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-1646
Practice Address - Country:US
Practice Address - Phone:985-264-9828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.Z11125225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist