Healthcare Provider Details

I. General information

NPI: 1083528079
Provider Name (Legal Business Name): LEAH MARIE MULDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 1ST AVE N
GEORGE IA
51237-1029
US

IV. Provider business mailing address

1976 5TH AVE SE APT B
SIOUX CENTER IA
51250-2973
US

V. Phone/Fax

Practice location:
  • Phone: 712-475-3391
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number141074
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: