Provider Demographics
NPI:1285711218
Name:BACKMEYER, LEANNE E (MSOTR)
Entity type:Individual
Prefix:
First Name:LEANNE
Middle Name:E
Last Name:BACKMEYER
Suffix:
Gender:F
Credentials:MSOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 CHESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1908
Mailing Address - Country:US
Mailing Address - Phone:765-983-3092
Mailing Address - Fax:765-983-3237
Practice Address - Street 1:1401 CHESTER BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374
Practice Address - Country:US
Practice Address - Phone:765-983-3092
Practice Address - Fax:765-983-3237
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31003794A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200689010Medicaid