Provider Demographics
NPI:1023662319
Name:MURPHY, LEAH DAWN (COTA/L)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:DAWN
Last Name:MURPHY
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 1:15537 STATE HIGHWAY Y
Mailing Address - Street 2:
Mailing Address - City:GREENTOP
Mailing Address - State:MO
Mailing Address - Zip Code:63546-4223
Mailing Address - Country:US
Mailing Address - Phone:660-626-6036
Mailing Address - Fax:
Practice Address - Street 1:1705 E LA HARPE ST
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501
Practice Address - Country:US
Practice Address - Phone:660-665-3774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019025848224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant