Provider Demographics
NPI:1861369894
Name:WACHSSTOCK, LEIA MINA (OTR/L)
Entity type:Individual
Prefix:
First Name:LEIA
Middle Name:MINA
Last Name:WACHSSTOCK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:LEIA
Other - Middle Name:
Other - Last Name:RUBIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:869 BERICK DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132-4808
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8 MILLSTONE CAMPUS DR STE 1000
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-5761
Practice Address - Country:US
Practice Address - Phone:314-648-8266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-23
Last Update Date:2025-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation