Provider Demographics
NPI:1912565276
Name:LEIGHTON, LISA (OTR/L)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:LEIGHTON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 W SIDE RD
Mailing Address - Street 2:
Mailing Address - City:TREVETT
Mailing Address - State:ME
Mailing Address - Zip Code:04571-3027
Mailing Address - Country:US
Mailing Address - Phone:207-272-4935
Mailing Address - Fax:207-633-1276
Practice Address - Street 1:6 SAINT ANDREWS LN
Practice Address - Street 2:
Practice Address - City:BOOTHBAY HARBOR
Practice Address - State:ME
Practice Address - Zip Code:04538-1731
Practice Address - Country:US
Practice Address - Phone:207-633-1894
Practice Address - Fax:207-633-1276
Is Sole Proprietor?:No
Enumeration Date:2019-06-03
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT2023225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist