Provider Demographics
NPI:1649848581
Name:BURKEY, LEIGH ALLISON (OTR/L)
Entity type:Individual
Prefix:
First Name:LEIGH
Middle Name:ALLISON
Last Name:BURKEY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:LEUGH
Other - Middle Name:ALLISON
Other - Last Name:BURKEY FONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:293 BUTTERFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANSELMO
Mailing Address - State:CA
Mailing Address - Zip Code:94960-1240
Mailing Address - Country:US
Mailing Address - Phone:925-787-3593
Mailing Address - Fax:
Practice Address - Street 1:350 GATE 5 RD
Practice Address - Street 2:
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965-2805
Practice Address - Country:US
Practice Address - Phone:415-339-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5040225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5040OtherCALIFORNIA BOARD OF OCCUPATIONAL THERAY (CBOT)
1049397OtherNATIONAL BOARD FOR CERTIFICATION IN OCCUPATIONAL THERAPY, INC. (NBCOT)