Provider Demographics
NPI:1578969150
Name:MIKULSKI, LEAH (MSOTR/L)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:
Last Name:MIKULSKI
Suffix:
Gender:F
Credentials:MSOTR/L
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:
Other - Last Name:REDINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSOTR/L
Mailing Address - Street 1:639 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:LARKSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18651-1409
Mailing Address - Country:US
Mailing Address - Phone:570-239-5151
Mailing Address - Fax:
Practice Address - Street 1:639 W STATE ST
Practice Address - Street 2:
Practice Address - City:LARKSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18651-1409
Practice Address - Country:US
Practice Address - Phone:570-239-5151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-10
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC013211225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist