Provider Demographics
NPI:1225594047
Name:HENDERSON, LEAH A (NA I, COTA/L)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:A
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:NA I, COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 MITCHELL AVE
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-6240
Mailing Address - Country:US
Mailing Address - Phone:704-770-1665
Mailing Address - Fax:
Practice Address - Street 1:1240 ARBOR RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104-1106
Practice Address - Country:US
Practice Address - Phone:336-724-7921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-17
Last Update Date:2019-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12017224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant