Provider Demographics
NPI:1639112717
Name:LEINGANG, BRIAN L (OTRIL,CHT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:L
Last Name:LEINGANG
Suffix:
Gender:M
Credentials:OTRIL,CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2204 ROBIN AVE
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-5751
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1242 S MORRISON BLVD STE O
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-5702
Practice Address - Country:US
Practice Address - Phone:985-402-3103
Practice Address - Fax:924-782-2985
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2020-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ12371225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAZ12371Medicare ID - Type UnspecifiedMEDICARE PROVIDER #