Provider Demographics
NPI:1871704965
Name:LEIGHTON, DINA B (LOTR)
Entity type:Individual
Prefix:MS
First Name:DINA
Middle Name:B
Last Name:LEIGHTON
Suffix:
Gender:F
Credentials:LOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 13251
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71315-3251
Mailing Address - Country:US
Mailing Address - Phone:318-730-3632
Mailing Address - Fax:318-487-0417
Practice Address - Street 1:1140 COLLEGE AVE LC COLLEGE POOL
Practice Address - Street 2:C/O PE DEPT DR SPEARS
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71359
Practice Address - Country:US
Practice Address - Phone:318-730-3632
Practice Address - Fax:318-487-0417
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ11380225XN1300X
225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAOTT211380OtherOFFICE OF GROUP BENEFITS OF LA