Provider Demographics
NPI:1467123968
Name:KAUFMAN, LEAH MARIE (OTD)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:MARIE
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:MARIE
Other - Last Name:HURLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTD
Mailing Address - Street 1:290 HIGHLAND AVE UNIT 2C
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-1341
Mailing Address - Country:US
Mailing Address - Phone:508-654-1358
Mailing Address - Fax:
Practice Address - Street 1:19 CROSBY DR STE 140
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:01730-1401
Practice Address - Country:US
Practice Address - Phone:781-245-4446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13016225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist