Provider Demographics
NPI:1134294119
Name:ZEMKE, LEILA JEAN MARIE (OTR L)
Entity Type:Individual
Prefix:MRS
First Name:LEILA
Middle Name:JEAN MARIE
Last Name:ZEMKE
Suffix:
Gender:F
Credentials:OTR L
Other - Prefix:MISS
Other - First Name:LEILA
Other - Middle Name:JEAN
Other - Last Name:BENNARDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR L
Mailing Address - Street 1:31 BEDIVERE BLVD
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718
Mailing Address - Country:US
Mailing Address - Phone:406-587-5259
Mailing Address - Fax:406-587-5259
Practice Address - Street 1:104 E MAIN ST
Practice Address - Street 2:SUITE 316
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715
Practice Address - Country:US
Practice Address - Phone:406-556-8770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT661100OtherBCBS
MT0000346885Medicaid
MT661100OtherBCBS