Provider Demographics
NPI:1215408786
Name:LEACH, KERI (OTR/L)
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:
Last Name:LEACH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KERI
Other - Middle Name:
Other - Last Name:KORALESKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:9567 PARK DR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68127-5202
Mailing Address - Country:US
Mailing Address - Phone:402-658-5297
Mailing Address - Fax:
Practice Address - Street 1:9567 PARK DR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68127-5202
Practice Address - Country:US
Practice Address - Phone:402-658-5297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-10
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2258225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist