Provider Demographics
NPI:1619481082
Name:LEANN CARGILE , OTR, LLC
Entity Type:Organization
Organization Name:LEANN CARGILE , OTR, LLC
Other - Org Name:SKILL BUILDERS THERAPY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEANN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARGILE
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:903-258-0807
Mailing Address - Street 1:11231 MARSH WREN CIR
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:TX
Mailing Address - Zip Code:75762-8739
Mailing Address - Country:US
Mailing Address - Phone:903-258-0807
Mailing Address - Fax:903-686-1211
Practice Address - Street 1:615 S BROADWAY AVE STE 103
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-1668
Practice Address - Country:US
Practice Address - Phone:903-258-0807
Practice Address - Fax:903-686-1211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-21
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106193225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty