Provider Demographics
NPI:1841575180
Name:LEATH, DONNA EILEEN (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:EILEEN
Last Name:LEATH
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 LINDA CIR
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:GA
Mailing Address - Zip Code:30736-6714
Mailing Address - Country:US
Mailing Address - Phone:423-227-2714
Mailing Address - Fax:
Practice Address - Street 1:615 DERBY ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-1632
Practice Address - Country:US
Practice Address - Phone:423-493-2922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2031224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant