Provider Demographics
NPI:1649748260
Name:DEWHITT, LEAH MICHELLE
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:MICHELLE
Last Name:DEWHITT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11880 LAUREL LN
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-3436
Mailing Address - Country:US
Mailing Address - Phone:918-568-2226
Mailing Address - Fax:
Practice Address - Street 1:11880 LAUREL LN
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-3436
Practice Address - Country:US
Practice Address - Phone:918-568-2226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK175T00000X
175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist