Provider Demographics
NPI:1366731689
Name:RUTT, LEANNE M (OT)
Entity type:Individual
Prefix:MRS
First Name:LEANNE
Middle Name:M
Last Name:RUTT
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1249 COCOA AVE
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-1715
Mailing Address - Country:US
Mailing Address - Phone:717-835-0310
Mailing Address - Fax:717-835-0314
Practice Address - Street 1:1249 COCOA AVE
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-1715
Practice Address - Country:US
Practice Address - Phone:717-835-0310
Practice Address - Fax:717-835-0314
Is Sole Proprietor?:No
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC009110225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOC009110OtherBUREAU OF PROFESSIONAL AND OCCUPATIONAL AFFAIRS