Provider Demographics
NPI:1124455845
Name:PHILLIPS, LEAH (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2775
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO FALLS
Mailing Address - State:MA
Mailing Address - Zip Code:02763-0897
Mailing Address - Country:US
Mailing Address - Phone:508-212-0352
Mailing Address - Fax:
Practice Address - Street 1:171 PLEASANT VIEW AVE
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02917-1792
Practice Address - Country:US
Practice Address - Phone:508-212-0352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIOT01190225X00000X
MA2530225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist