Provider Demographics
NPI:1427261841
Name:SERRANO, LEANNA JOY LONG (MOT, OTR/L)
Entity type:Individual
Prefix:MS
First Name:LEANNA
Middle Name:JOY LONG
Last Name:SERRANO
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98274 NOOKACHAMP HILLS DRIVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274
Mailing Address - Country:US
Mailing Address - Phone:808-927-7762
Mailing Address - Fax:
Practice Address - Street 1:98274 NOOKACHAMP HILLS DR
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-9167
Practice Address - Country:US
Practice Address - Phone:808-927-7762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00004344225X00000X, 225X00000X
OR1069010225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist