Provider Demographics
NPI:1851743660
Name:EDGINGTON, LEAH (PTA)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:EDGINGTON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11720 16TH RD SW
Mailing Address - Street 2:
Mailing Address - City:STOUTSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43154-9503
Mailing Address - Country:US
Mailing Address - Phone:740-412-9974
Mailing Address - Fax:
Practice Address - Street 1:11720 16TH RD SW
Practice Address - Street 2:
Practice Address - City:STOUTSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43154-9503
Practice Address - Country:US
Practice Address - Phone:740-412-9974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10384174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist