Provider Demographics
NPI:1598000754
Name:BECKER, LEANNE (OT)
Entity Type:Individual
Prefix:
First Name:LEANNE
Middle Name:
Last Name:BECKER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 JOYCE DR
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-8412
Mailing Address - Country:US
Mailing Address - Phone:406-241-4989
Mailing Address - Fax:406-777-5856
Practice Address - Street 1:10 JOYCE DR
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-8412
Practice Address - Country:US
Practice Address - Phone:406-241-4989
Practice Address - Fax:406-777-5856
Is Sole Proprietor?:No
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1033225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1033OtherSTATE OF MONTANA