Provider Demographics
NPI:1790285880
Name:LEAFTY, CARLA KAY (COTA)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:KAY
Last Name:LEAFTY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8452 W SHOOTING STAR DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-7846
Mailing Address - Country:US
Mailing Address - Phone:208-540-0688
Mailing Address - Fax:
Practice Address - Street 1:1745 PIKE AVE
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99354-2295
Practice Address - Country:US
Practice Address - Phone:509-946-8095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant