Provider Demographics
NPI:1346299385
Name:COOPER, LEAH E (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:LEAH
Middle Name:E
Last Name:COOPER
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 1:140 SUNNYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-9628
Mailing Address - Country:US
Mailing Address - Phone:870-307-5724
Mailing Address - Fax:
Practice Address - Street 1:130 UNDERHILL RD
Practice Address - Street 2:
Practice Address - City:BEEBE
Practice Address - State:AR
Practice Address - Zip Code:72012-9751
Practice Address - Country:US
Practice Address - Phone:501-230-3100
Practice Address - Fax:501-882-9825
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR1996225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR157463721Medicaid