Provider Demographics
NPI:1568545929
Name:LEIER, ANNETTE J (MED OTR L)
Entity Type:Individual
Prefix:MS
First Name:ANNETTE
Middle Name:J
Last Name:LEIER
Suffix:
Gender:F
Credentials:MED OTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4325 LAUREL ST STE 102
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5364
Mailing Address - Country:US
Mailing Address - Phone:907-569-5660
Mailing Address - Fax:855-449-4489
Practice Address - Street 1:4325 LAUREL ST STE 102
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5364
Practice Address - Country:US
Practice Address - Phone:907-569-5660
Practice Address - Fax:855-499-4489
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-21
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK347225X00000X, 225XF0002X
AKOT347225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XF0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistFeeding, Eating & Swallowing
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKOT3347Medicaid