Healthcare Provider Details

I. General information

NPI: 1730061417
Provider Name (Legal Business Name): LEIGHA DARYANANI OTD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2025
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 CAPITAL MALL DR SW STE A
OLYMPIA WA
98502-8654
US

IV. Provider business mailing address

3901 CAPITAL MALL DR SW STE D
OLYMPIA WA
98502-8654
US

V. Phone/Fax

Practice location:
  • Phone: 360-709-6230
  • Fax:
Mailing address:
  • Phone: 360-709-6221
  • Fax: 360-359-4727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT70030344
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: