Provider Demographics
NPI:1720467343
Name:LEDING, MICHEAL ANTHONY II (COTA/L)
Entity type:Individual
Prefix:MR
First Name:MICHEAL
Middle Name:ANTHONY
Last Name:LEDING
Suffix:II
Gender:M
Credentials:COTA/L
Other - Prefix:MR
Other - First Name:MICHAEL
Other - Middle Name:ANTHONY
Other - Last Name:LEDING
Other - Suffix:II
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1001 N 49TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72904-7211
Mailing Address - Country:US
Mailing Address - Phone:479-209-4490
Mailing Address - Fax:
Practice Address - Street 1:1001 N 49TH ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72904-7211
Practice Address - Country:US
Practice Address - Phone:479-209-4490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A967224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant