Provider Demographics
NPI:1821210576
Name:LEINGANG, ALESIA ANNE (OT)
Entity Type:Individual
Prefix:
First Name:ALESIA
Middle Name:ANNE
Last Name:LEINGANG
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5208 ALEXANDER DR
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70003-2506
Mailing Address - Country:US
Mailing Address - Phone:504-236-2088
Mailing Address - Fax:504-281-4260
Practice Address - Street 1:5208 ALEXANDER DR
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70003-2506
Practice Address - Country:US
Practice Address - Phone:504-236-2088
Practice Address - Fax:504-281-4260
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.Z12361225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1310131Medicaid