Provider Demographics
NPI:1306332184
Name:WARNER, LEAH SHANNON (MS, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:SHANNON
Last Name:WARNER
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:MS
Other - First Name:LEAH
Other - Middle Name:SHANNON
Other - Last Name:OLIVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:1100 MAXWELL LANE
Mailing Address - Street 2:UNIT 638
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030
Mailing Address - Country:US
Mailing Address - Phone:908-797-9077
Mailing Address - Fax:718-886-8694
Practice Address - Street 1:1100 MAXWELL LANE
Practice Address - Street 2:UNIT 638
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030
Practice Address - Country:US
Practice Address - Phone:718-762-7633
Practice Address - Fax:718-886-8694
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-05
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022640225X00000X
NJ46TR00937200225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY022640OtherOCCUPATIONAL THERAPY LICENSE LUMBER
401876OtherNBCOT REGISTRATION