Basic Information
| Provider Information | |||||||||
| NPI: | 1295088128 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEITZEL | ||||||||
| FirstName: | SARAH | ||||||||
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| Credential: | COTA/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 346 MOOSE RUN RD APT 2 | ||||||||
| Address2: | |||||||||
| City: | BELLEFONTE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 168234812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172507395 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2901 E BARNETT RD | ||||||||
| Address2: | |||||||||
| City: | MEDFORD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975048308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417794221 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2012 | ||||||||
| LastUpdateDate: | 10/16/2012 | ||||||||
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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 | 224Z00000X | 222134 | OR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.