Provider Demographics
NPI:1467742478
Name:VITALE, LEAH MICHELE (OTR/L)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:MICHELE
Last Name:VITALE
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 1:35 TRENTON AVE
Mailing Address - Street 2:
Mailing Address - City:EAST ATLANTIC BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-1132
Mailing Address - Country:US
Mailing Address - Phone:401-580-2424
Mailing Address - Fax:
Practice Address - Street 1:35 TRENTON AVE
Practice Address - Street 2:
Practice Address - City:EAST ATLANTIC BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-1132
Practice Address - Country:US
Practice Address - Phone:401-580-2424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2023-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016692-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist