Provider Demographics
NPI:1508092966
Name:WIGGINS- MARSHALLL, LEAH MARIA ANTOINTTE
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:MARIA ANTOINTTE
Last Name:WIGGINS- MARSHALLL
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 1:5579 S HANNIBAL WAY
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80015-4277
Mailing Address - Country:US
Mailing Address - Phone:303-617-4357
Mailing Address - Fax:
Practice Address - Street 1:5579 S HANNIBAL WAY
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80015-4277
Practice Address - Country:US
Practice Address - Phone:303-617-4357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-29
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO588134225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist