Provider Demographics
NPI:1437863842
Name:LEGER, AMANDA KELLI (LOTR)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:KELLI
Last Name:LEGER
Suffix:
Gender:F
Credentials:LOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 HANCHEY RD
Mailing Address - Street 2:
Mailing Address - City:DRY CREEK
Mailing Address - State:LA
Mailing Address - Zip Code:70637-5111
Mailing Address - Country:US
Mailing Address - Phone:337-965-2813
Mailing Address - Fax:
Practice Address - Street 1:19503 HWY 171
Practice Address - Street 2:
Practice Address - City:DERIDDER
Practice Address - State:LA
Practice Address - Zip Code:70634
Practice Address - Country:US
Practice Address - Phone:337-202-7045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA333943225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist