Provider Demographics
NPI:1417386897
Name:PRICE, LEAH (OTR)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:PRICE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:K
Other - Last Name:KALKA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR
Mailing Address - Street 1:610 DOGWOOD ST
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-4340
Mailing Address - Country:US
Mailing Address - Phone:979-285-7114
Mailing Address - Fax:
Practice Address - Street 1:610 DOGWOOD ST
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-4340
Practice Address - Country:US
Practice Address - Phone:979-285-7114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105899225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist