Provider Demographics
NPI:1750774659
Name:LEATHERMAN, CORINNE
Entity type:Individual
Prefix:
First Name:CORINNE
Middle Name:
Last Name:LEATHERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CORINNE
Other - Middle Name:
Other - Last Name:LEATHERMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:2407 CHESTNUT LN
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:28337-9545
Mailing Address - Country:US
Mailing Address - Phone:910-633-9329
Mailing Address - Fax:
Practice Address - Street 1:208 MERCER ROAD
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:NC
Practice Address - Zip Code:28337
Practice Address - Country:US
Practice Address - Phone:910-862-6400
Practice Address - Fax:910-862-6402
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9448225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist