Provider Demographics
NPI:1558315770
Name:SWAIN, LEAH LYNN (COTA)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:LYNN
Last Name:SWAIN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 WAKE FOREST BUSINESS PARK
Mailing Address - Street 2:SUITE D
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-6523
Mailing Address - Country:US
Mailing Address - Phone:919-556-1700
Mailing Address - Fax:919-556-1245
Practice Address - Street 1:833 WAKE FOREST BUSINESS PARK
Practice Address - Street 2:SUITE D
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-6523
Practice Address - Country:US
Practice Address - Phone:919-556-1700
Practice Address - Fax:919-556-1245
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5972224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant