Provider Demographics
NPI:1528589165
Name:MCBRYDE, LEAH BLACK
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:BLACK
Last Name:MCBRYDE
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:PO BOX 354
Mailing Address - Street 2:
Mailing Address - City:WEST END
Mailing Address - State:NC
Mailing Address - Zip Code:27376-0354
Mailing Address - Country:US
Mailing Address - Phone:910-673-5437
Mailing Address - Fax:910-673-5438
Practice Address - Street 1:1163 7 LAKES DR
Practice Address - Street 2:
Practice Address - City:WEST END
Practice Address - State:NC
Practice Address - Zip Code:27376
Practice Address - Country:US
Practice Address - Phone:910-673-5437
Practice Address - Fax:910-673-5438
Is Sole Proprietor?:No
Enumeration Date:2017-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8171225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist