Provider Demographics
NPI:1568607216
Name:LEAVELL, PATRICIA (OTR)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:LEAVELL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1323 S ASH ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:MO
Mailing Address - Zip Code:65622-9311
Mailing Address - Country:US
Mailing Address - Phone:417-345-2222
Mailing Address - Fax:417-345-8446
Practice Address - Street 1:1323 S ASH ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MO
Practice Address - Zip Code:65622-9311
Practice Address - Country:US
Practice Address - Phone:417-345-2222
Practice Address - Fax:417-345-8446
Is Sole Proprietor?:No
Enumeration Date:2008-12-10
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004028803224Z00000X
MO2020008569225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant