Provider Demographics
NPI:1093038812
Name:GROSS, LEAH (OT)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:GROSS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 HILLSIDE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-3394
Mailing Address - Country:US
Mailing Address - Phone:732-813-4263
Mailing Address - Fax:732-813-4264
Practice Address - Street 1:110 HILLSIDE BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-3394
Practice Address - Country:US
Practice Address - Phone:732-813-4263
Practice Address - Fax:732-813-4264
Is Sole Proprietor?:No
Enumeration Date:2010-03-08
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist