Provider Demographics
NPI:1962088153
Name:DIMALANTA, LEAH ASHLEY GUERRERO (OTR/L)
Entity type:Individual
Prefix:
First Name:LEAH ASHLEY
Middle Name:GUERRERO
Last Name:DIMALANTA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 POWER CIR
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-2538
Mailing Address - Country:US
Mailing Address - Phone:310-613-4274
Mailing Address - Fax:
Practice Address - Street 1:4500 13TH ST STE 900
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-2515
Practice Address - Country:US
Practice Address - Phone:228-822-6965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist