Healthcare Provider Details

I. General information

NPI: 1225947633
Provider Name (Legal Business Name): LEAH JULIET KORNGUTH OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 WATERTOWN ST
LEXINGTON MA
02421-6331
US

IV. Provider business mailing address

33 MICHELLE LN
GUILFORD CT
06437-2906
US

V. Phone/Fax

Practice location:
  • Phone: 603-484-4070
  • Fax: 603-881-5280
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTL36835
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: