Basic Information
| Provider Information | |||||||||
| NPI: | 1790285880 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEAFTY | ||||||||
| FirstName: | CARLA | ||||||||
| MiddleName: | KAY | ||||||||
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| Credential: | COTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8452 W SHOOTING STAR DR | ||||||||
| Address2: | |||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 837097846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2085400688 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1745 PIKE AVE | ||||||||
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| City: | RICHLAND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993542295 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5099468095 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2018 | ||||||||
| LastUpdateDate: | 02/15/2018 | ||||||||
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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 | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.