Healthcare Provider Details

I. General information

NPI: 1457802878
Provider Name (Legal Business Name): LEAH MCGRATH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2016
Last Update Date: 10/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8301 E. PRENTICE AVE SUITE 207
ENGLEWOOD CO
80112
US

IV. Provider business mailing address

785 S AVENIDA DEL ORO E
PUEBLO WEST CO
81007-2032
US

V. Phone/Fax

Practice location:
  • Phone: 719-630-8099
  • Fax:
Mailing address:
  • Phone: 719-214-7511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA.0000780
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: