Basic Information
| Provider Information | |||||||||
| NPI: | 1528084589 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEEDY | ||||||||
| FirstName: | DEBORAH | ||||||||
| MiddleName: | E. | ||||||||
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| Credential: | OT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 90 JACKSON PIKE | ||||||||
| Address2: | |||||||||
| City: | GALLIPOLIS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456311560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404465244 | ||||||||
| FaxNumber: | 7404465448 | ||||||||
| Practice Location | |||||||||
| Address1: | 1051 4TH AVE | ||||||||
| Address2: | |||||||||
| City: | GALLIPOLIS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403958801 | ||||||||
| FaxNumber: | 7403958855 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2006 | ||||||||
| LastUpdateDate: | 02/18/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT.000022 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 0823676 | 01 | OH | MOLINA MEDICAID | OTHER | 000000217244 | 01 | ANTHEM BCBS | OTHER | 0071074 | 05 | OH | MEDICAID | 670001490 | 01 | RR MEDICARE | OTHER | 7502027000 | 05 | WV | MEDICAID |