Healthcare Provider Details

I. General information

NPI: 1720287402
Provider Name (Legal Business Name): LEAH LORENE DOWTY PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 07/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 W ADAMS ST CORN HERITAGE NURSING HOME
CORN OK
73024
US

IV. Provider business mailing address

RT. 2 BOX 38A
HYDRO OK
73048
US

V. Phone/Fax

Practice location:
  • Phone: 580-330-0609
  • Fax:
Mailing address:
  • Phone: 580-330-0609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1413
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: