Provider Demographics
NPI:1558790568
Name:GREENE, LEIGH WALKER (LOTR)
Entity Type:Individual
Prefix:MRS
First Name:LEIGH
Middle Name:WALKER
Last Name:GREENE
Suffix:
Gender:F
Credentials:LOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3435 WESTERVELT AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70820-5041
Mailing Address - Country:US
Mailing Address - Phone:225-978-9742
Mailing Address - Fax:
Practice Address - Street 1:8130 KELWOOD AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-4843
Practice Address - Country:US
Practice Address - Phone:225-771-8173
Practice Address - Fax:225-771-8126
Is Sole Proprietor?:No
Enumeration Date:2013-11-11
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.Z12183225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics