Healthcare Provider Details

I. General information

NPI: 1821687484
Provider Name (Legal Business Name): LEAH LAFAY BAKER-SMITH OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2021
Last Update Date: 01/18/2021
Certification Date: 01/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1529 SUNRISE PLAZA DR
CLERMONT FL
34714-6202
US

IV. Provider business mailing address

2008 DR MARTIN L KING JR WAY
HAINES CITY FL
33844-2459
US

V. Phone/Fax

Practice location:
  • Phone: 352-243-9341
  • Fax:
Mailing address:
  • Phone: 863-510-3143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number21486
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: