Provider Demographics
NPI:1588290043
Name:CHAN, LEAH KATHERINE (OTR/L)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:KATHERINE
Last Name:CHAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 QUEEN ANNE CT
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-1733
Mailing Address - Country:US
Mailing Address - Phone:717-756-0991
Mailing Address - Fax:
Practice Address - Street 1:267 FREDERICK ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-3614
Practice Address - Country:US
Practice Address - Phone:717-637-8937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-17
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC016748225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist