Basic Information
| Provider Information | |||||||||
| NPI: | 1629548219 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ADEKOYA | ||||||||
| FirstName: | LEAH | ||||||||
| MiddleName: | MORGAN | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MOT, OTR/L | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | WISEMAN | ||||||||
| OtherFirstName: | LEAH | ||||||||
| OtherMiddleName: | MORGAN | ||||||||
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| OtherCredential: | MSOT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 90 HOWARD DR | ||||||||
| Address2: | |||||||||
| City: | SHELBYVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 400658138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026331007 | ||||||||
| FaxNumber: | 5028051511 | ||||||||
| Practice Location | |||||||||
| Address1: | 261 RUCCIO WAY | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405033662 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8598992022 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/27/2018 | ||||||||
| LastUpdateDate: | 08/29/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XP0200X | 245350 | KY | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics | 225X00000X | 245350 | KY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.