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General NPI Number Information
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NPI Number | 1124401328
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Entity Type | Individual
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Provider Name | TANYA LEAHY
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Gender | Female
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Dates
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Enumeration Date | 07/07/2015
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Last Update Date | 07/24/2015
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Provider Practice Location Address
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Address Line | 530 RIVER AVE S
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City | PRAIRIE FARM
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State | WI
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Zip | 54762-9791
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Country | US
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Telephone | 715-455-1178
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 52
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City | CAMERON
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State | WI
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Zip | 54822-0052
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Country | US
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Telephone | 715-764-0212
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 5129-27
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License Number State | WI
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