Provider Demographics
NPI:1235266321
Name:BURRY, LEAH ELIZABETH (COTAL)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:ELIZABETH
Last Name:BURRY
Suffix:
Gender:F
Credentials:COTAL
Other - Prefix:MISS
Other - First Name:LEAH
Other - Middle Name:ELIZABETH
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 585
Mailing Address - Street 2:
Mailing Address - City:PEA RIDGE
Mailing Address - State:AR
Mailing Address - Zip Code:72751-0585
Mailing Address - Country:US
Mailing Address - Phone:479-273-2345
Mailing Address - Fax:479-273-9391
Practice Address - Street 1:2705 SE G ST STE 1
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-3742
Practice Address - Country:US
Practice Address - Phone:479-273-2345
Practice Address - Fax:479-273-9391
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTA441224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant