Provider Demographics
NPI:1588287056
Name:LEEDY, SHARLENE (OT)
Entity type:Individual
Prefix:
First Name:SHARLENE
Middle Name:
Last Name:LEEDY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:SHARLENE
Other - Middle Name:
Other - Last Name:LAVARIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15774 NE 101ST CT
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-1006
Mailing Address - Country:US
Mailing Address - Phone:206-854-4140
Mailing Address - Fax:
Practice Address - Street 1:4217 170TH CT NE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-5494
Practice Address - Country:US
Practice Address - Phone:206-854-4140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-19
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60855891225XE0001X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XE0001XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistEnvironmental Modification