Provider Demographics
NPI:1093131203
Name:TETA, LEAH H (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:H
Last Name:TETA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:LEAH
Other - Middle Name:CAROL
Other - Last Name:HUDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:6330 TROON LANE SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501
Mailing Address - Country:US
Mailing Address - Phone:318-572-4955
Mailing Address - Fax:
Practice Address - Street 1:6330 TROON LN SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-9108
Practice Address - Country:US
Practice Address - Phone:318-572-4955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT60407144225X00000X
LAOTT.Z12384225X00000X
TX109966225X00000X
TN3662225X00000X
KYR3652225X00000X
NC5594225X00000X
CA12141225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist