Provider Demographics
NPI:1154489995
Name:MOTZKO, LEAH CAROL (OTR)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:CAROL
Last Name:MOTZKO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 VICKIE CIR
Mailing Address - Street 2:
Mailing Address - City:BERRYVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72616-5202
Mailing Address - Country:US
Mailing Address - Phone:870-480-9085
Mailing Address - Fax:870-533-5533
Practice Address - Street 1:909 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GREEN FOREST
Practice Address - State:AR
Practice Address - Zip Code:72638-2316
Practice Address - Country:US
Practice Address - Phone:870-480-9085
Practice Address - Fax:870-533-5533
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR973225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR132384721Medicaid