Provider Demographics
NPI:1518230655
Name:OTIS, LEIGH ANN (ATC)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:ANN
Last Name:OTIS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4254 W 4850 S
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:UT
Mailing Address - Zip Code:84067-8780
Mailing Address - Country:US
Mailing Address - Phone:801-645-7965
Mailing Address - Fax:
Practice Address - Street 1:2430 N HILL FIELD RD
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-4717
Practice Address - Country:US
Practice Address - Phone:801-645-7965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer