Provider Demographics
NPI:1275209124
Name:LEATHERBURY, LYNSAY (COTA)
Entity Type:Individual
Prefix:
First Name:LYNSAY
Middle Name:
Last Name:LEATHERBURY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 3RD STREET
Mailing Address - Street 2:
Mailing Address - City:VICI
Mailing Address - State:OK
Mailing Address - Zip Code:73859
Mailing Address - Country:US
Mailing Address - Phone:405-514-2805
Mailing Address - Fax:580-256-1410
Practice Address - Street 1:2630 OKLAHOMA AVE
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:OK
Practice Address - Zip Code:73801-4010
Practice Address - Country:US
Practice Address - Phone:580-256-2102
Practice Address - Fax:580-256-1410
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-20
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant