Provider Demographics
NPI:1871902700
Name:MANSON, LEIGH (OT)
Entity type:Individual
Prefix:
First Name:LEIGH
Middle Name:
Last Name:MANSON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:LEIGH
Other - Middle Name:
Other - Last Name:FARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8561 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-6727
Mailing Address - Country:US
Mailing Address - Phone:330-953-2383
Mailing Address - Fax:330-953-2384
Practice Address - Street 1:8561 MARKET ST
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-6727
Practice Address - Country:US
Practice Address - Phone:330-953-2383
Practice Address - Fax:330-953-2384
Is Sole Proprietor?:No
Enumeration Date:2014-08-05
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT8592225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2577162Medicaid
OH2577162Medicaid