Provider Demographics
NPI:1063891356
Name:DERRING, LEAH HELEN (LMT)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:HELEN
Last Name:DERRING
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:473 GLYNBROOK ST N
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-5614
Mailing Address - Country:US
Mailing Address - Phone:585-749-2620
Mailing Address - Fax:
Practice Address - Street 1:473 GLYNBROOK ST N
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-5614
Practice Address - Country:US
Practice Address - Phone:585-749-2620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-20
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20426225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist