Provider Demographics
NPI:1538972369
Name:DOMANGUE, LEAH
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:DOMANGUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3598 HIGHWAY 452 APT 5
Mailing Address - Street 2:
Mailing Address - City:MARKSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71351-3581
Mailing Address - Country:US
Mailing Address - Phone:985-519-7399
Mailing Address - Fax:
Practice Address - Street 1:7408 HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:MANSURA
Practice Address - State:LA
Practice Address - Zip Code:71350-4204
Practice Address - Country:US
Practice Address - Phone:318-964-2198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant