Provider Demographics
NPI:1396550026
Name:ANDERSON, LEEANNE ANNE (OTA)
Entity type:Individual
Prefix:
First Name:LEEANNE
Middle Name:ANNE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3012 WILBRAHAM RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-1737
Mailing Address - Country:US
Mailing Address - Phone:513-903-5104
Mailing Address - Fax:
Practice Address - Street 1:3012 WILBRAHAM RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45042-1737
Practice Address - Country:US
Practice Address - Phone:513-903-5104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA02743224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant