Provider Demographics
NPI:1306004668
Name:STETHEN, LEITA MEREDITH (OTR/L)
Entity Type:Individual
Prefix:
First Name:LEITA
Middle Name:MEREDITH
Last Name:STETHEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 TIMBERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SMITHS GROVE
Mailing Address - State:KY
Mailing Address - Zip Code:42171-8244
Mailing Address - Country:US
Mailing Address - Phone:270-597-9723
Mailing Address - Fax:270-597-9723
Practice Address - Street 1:299 TIMBERWOOD DR
Practice Address - Street 2:
Practice Address - City:SMITHS GROVE
Practice Address - State:KY
Practice Address - Zip Code:42171-8244
Practice Address - Country:US
Practice Address - Phone:270-597-9723
Practice Address - Fax:270-597-9723
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR1044225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist