1760563589 NPI number — LEAH MORRISON FAME OCCUPATIONAL THERAPI

Table of content: LEAH MORRISON FAME OCCUPATIONAL THERAPI (NPI 1760563589)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760563589 NPI number — LEAH MORRISON FAME OCCUPATIONAL THERAPI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FAME
Provider First Name:
LEAH
Provider Middle Name:
MORRISON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OCCUPATIONAL THERAPI
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MORRISON
Provider Other First Name:
LEAH
Provider Other Middle Name:
KAY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
OCCUPATIONAL THERAPI
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1760563589
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
844 WEST MAIN STREET
Provider Second Line Business Mailing Address:
HEARTLAND REHABILITATION SERVICES
Provider Business Mailing Address City Name:
SALEM
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24153
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-387-4311
Provider Business Mailing Address Fax Number:
540-389-6212

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
844 WEST MAIN STREET
Provider Second Line Business Practice Location Address:
HEARTLAND REHABILITATION SERVICES
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24153
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-387-4311
Provider Business Practice Location Address Fax Number:
540-389-6212
Provider Enumeration Date:
10/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  0119000833 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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