MEDICARE: PATRICIA LEAVELL OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Z00000X	Occupational Therapy Assistant	2004028803	MO
2	225XP0200X	Pediatric Occupational Therapist	2020008569	MO

General Provider Information

NPI Number	:	1568607216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA LEAVELL OTR

Provider Business Mailing Address
First Line	:	1323 S ASH ST
Second Line	:
City	:	BUFFALO
State	:	MO
Zip	:	65622-9311
Country	:	US
Telephone Number	:	417-345-2222
Fax Number	:	417-345-8446

Provider Business Practice Location Address
First Line	:	1323 S ASH ST
Second Line	:
City	:	BUFFALO
State	:	MO
Zip	:	65622-9311
Country	:	US
Telephone Number	:	417-345-2222
Fax Number	:	417-345-8446

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/10/2008
Last Update Date	:	09/20/2021

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Directions to “ PATRICIA LEAVELL OTR” Practice Location

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