Healthcare Provider Details

I. General information

NPI: 1992629075
Provider Name (Legal Business Name): LEAH EMMICH OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1481 BYHALIA RD
HERNANDO MS
38632-1003
US

IV. Provider business mailing address

1481 BYHALIA RD
HERNANDO MS
38632-1003
US

V. Phone/Fax

Practice location:
  • Phone: 662-469-2906
  • Fax: 662-469-4229
Mailing address:
  • Phone: 662-469-2906
  • Fax: 662-469-4229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number4367
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: