Provider Demographics
NPI:1649521535
Name:ALLEN, LEIGH ANN (OCCUPATIONAL THERAPY)
Entity type:Individual
Prefix:
First Name:LEIGH ANN
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 CONSTITUTION DR STE 800
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-8001
Mailing Address - Country:US
Mailing Address - Phone:478-333-6363
Mailing Address - Fax:478-333-6076
Practice Address - Street 1:114 CONSTITUTION DR STE 800
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-8001
Practice Address - Country:US
Practice Address - Phone:478-333-6363
Practice Address - Fax:478-333-6076
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT003689174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist