Provider Demographics
NPI:1033813985
Name:GRAHAM-BOYER, LEANDREA EMILY
Entity Type:Individual
Prefix:
First Name:LEANDREA
Middle Name:EMILY
Last Name:GRAHAM-BOYER
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 1:1325 ELKHORN LAKE RD
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48362-2415
Mailing Address - Country:US
Mailing Address - Phone:248-672-8446
Mailing Address - Fax:
Practice Address - Street 1:1325 ELKHORN LAKE RD
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48362-2415
Practice Address - Country:US
Practice Address - Phone:248-672-8446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5202010026224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant