Provider Demographics
NPI:1437738317
Name:PRICE, LEIGHANNE MARIE
Entity Type:Individual
Prefix:
First Name:LEIGHANNE
Middle Name:MARIE
Last Name:PRICE
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 1:1105 TWIN OAKS CT
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:MO
Mailing Address - Zip Code:63080-1055
Mailing Address - Country:US
Mailing Address - Phone:573-854-1000
Mailing Address - Fax:
Practice Address - Street 1:311 N SPRING ST
Practice Address - Street 2:
Practice Address - City:STEELVILLE
Practice Address - State:MO
Practice Address - Zip Code:65565-5089
Practice Address - Country:US
Practice Address - Phone:573-260-8850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015004886224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant