MEDICARE: MRS. LEAH THOMPSON MCDANIEL MOTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	321713	LA

General Provider Information

NPI Number	:	1891144291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LEAH THOMPSON MCDANIEL MOTR/L

Provider Business Mailing Address
First Line	:	4109 HIGHWAY 98 W
Second Line	:
City	:	SUMMIT
State	:	MS
Zip	:	39666-9132
Country	:	US
Telephone Number	:	601-276-3900
Fax Number	:

Provider Business Practice Location Address
First Line	:	311 VETERANS BLVD
Second Line	:
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70726-4726
Country	:	US
Telephone Number	:	225-380-1894
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2016
Last Update Date	:	05/06/2021

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