Provider Demographics
NPI:1326528340
Name:RADMAN, LEAH ROBIN
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:ROBIN
Last Name:RADMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1948 270TH ST E
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MN
Mailing Address - Zip Code:55065-9515
Mailing Address - Country:US
Mailing Address - Phone:507-664-9668
Mailing Address - Fax:
Practice Address - Street 1:1948 270TH ST E
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MN
Practice Address - Zip Code:55065-9515
Practice Address - Country:US
Practice Address - Phone:507-664-9668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN102463225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist