Provider Demographics
NPI:1720287402
Name:DOWTY, LEAH LORENE (PTA)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:LORENE
Last Name:DOWTY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RT. 2 BOX 38A
Mailing Address - Street 2:
Mailing Address - City:HYDRO
Mailing Address - State:OK
Mailing Address - Zip Code:73048
Mailing Address - Country:US
Mailing Address - Phone:580-330-0609
Mailing Address - Fax:
Practice Address - Street 1:106 W ADAMS ST
Practice Address - Street 2:CORN HERITAGE NURSING HOME
Practice Address - City:CORN
Practice Address - State:OK
Practice Address - Zip Code:73024
Practice Address - Country:US
Practice Address - Phone:580-330-0609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1413225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant