Basic Information
| Provider Information | |||||||||
| NPI: | 1255368171 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEITTEN | ||||||||
| FirstName: | ANN | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | OTRC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2128 ELMWOOD AVENUE | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142071910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168744500 | ||||||||
| FaxNumber: | 7168748145 | ||||||||
| Practice Location | |||||||||
| Address1: | 2128 ELMWOOD AVENUE | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142071910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168744500 | ||||||||
| FaxNumber: | 7168748145 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 040511000063 | 01 | FIDELIS FAMILY HEALTH PLU | OTHER | 000670011001 | 01 | CHP FHP 201 | OTHER | 000733832001 | 01 | COMMUNITY CARE | OTHER | 1600573 | 01 | GROUP HEALTH INS PPO CBP | OTHER | 000670011001 | 01 | BC BS WNY | OTHER | 01465154 | 05 | NY | MEDICAID | 040511000063 | 01 | FIDELIS CHILD HEALTH PLUS | OTHER | 040511000063 | 01 | NORTH AMERICAN PREFERRED | OTHER | 00011249902 | 01 | ASO | OTHER | 040511000063 | 01 | FIDELIS MEDICAID | OTHER | 0000670011001 | 01 | COMMUNITY BLUE STD HMO | OTHER | 000670011001 | 01 | CB ADVANTAGE HMO | OTHER | 000670011001 | 01 | TRADITIONAL SECURE BLUE | OTHER | 7400120 | 01 | AETNA | OTHER | 00011249902 | 01 | UNIVERA HEALTHCARE TRAD | OTHER | 00011249902 | 01 | UNIVERA COMMERCIAL | OTHER | 000670011001 | 01 | CB LABOR HEALTH HMO | OTHER |