Provider Demographics
NPI:1861008195
Name:MASHBURN, LEAH (MOT/ OTR,L)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:MASHBURN
Suffix:
Gender:F
Credentials:MOT/ OTR,L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 S EUCALYPTUS AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-5996
Mailing Address - Country:US
Mailing Address - Phone:918-608-1212
Mailing Address - Fax:918-289-2606
Practice Address - Street 1:1605 S EUCALYPTUS AVE STE 200
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-5996
Practice Address - Country:US
Practice Address - Phone:918-608-1212
Practice Address - Fax:918-289-2606
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-22
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5485225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK5485OtherOKLAHOMA STATE BOARD OF MEDICAL LICENSURE AND SUPERVISION