Active NPI
Leslie Ann Wallace, OT
- Occupational Therapist
- Ronan, MT
National Provider Identifier
1750444956
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 186
- Practice address
- 43922 Canal Rd
Ronan, MT 59864-9192 - Phone
- (406) 676-2912
- Fax
- (406) 676-2912
- NPI assigned
- Dec 18, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 186 | MT | Primary |
| Pediatric Occupational Therapist | 225XP0200X | 186 | MT |
Addresses
Primary practice location
43922 Canal Rd
Ronan, MT 59864-9192
Mailing address
43922 Canal Rd
Ronan, MT 59864-9192
Phone (406) 676-2912
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0341343 | Medicaid | MT | |
| 66351 | Other | MT | BCBS PROVIDER NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 186 | MT | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166400000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757548800000",
"number": "1750444956",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "43922 CANAL RD",
"city": "RONAN",
"state": "MT",
"postal_code": "598649192",
"telephone_number": "406-676-2912",
"fax_number": "406-676-2912"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "43922 CANAL RD",
"city": "RONAN",
"state": "MT",
"postal_code": "598649192",
"telephone_number": "406-676-2912",
"fax_number": "406-676-2912"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "LESLIE",
"middle_name": "ANN",
"name_prefix": "Ms.",
"credential": "OT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-18",
"last_updated": "2025-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MT",
"license": "186",
"primary": true
},
{
"code": "225XP0200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Pediatrics",
"state": "MT",
"license": "186",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0341343",
"state": "MT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS PROVIDER NUMBER",
"identifier": "66351",
"state": "MT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ronan, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.