Provider Demographics
NPI:1790567386
Name:POWELL HOSSEINABAD, LEAH A (OTR/L)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:A
Last Name:POWELL HOSSEINABAD
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:A
Other - Last Name:POWELL-MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7320 WHITESTONE DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-1769
Mailing Address - Country:US
Mailing Address - Phone:402-429-7781
Mailing Address - Fax:
Practice Address - Street 1:8525 EXECUTIVE WOODS DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68512-9648
Practice Address - Country:US
Practice Address - Phone:402-942-1329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2520225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist