Active NPI
Lara Victoria Leach
- Occupational Therapy Assistant
- Stillwater, OK
National Provider Identifier
1144725524
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 1922
- Practice address
- 814 S Walnut St
Stillwater, OK 74074-4225 - Phone
- (405) 377-8255
- NPI assigned
- Mar 27, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 1922 | OK | Primary |
Addresses
Primary practice location
814 S Walnut St
Stillwater, OK 74074-4225
Mailing address
4514 Classen CT
Stillwater, OK 74075-1631
Phone (405) 780-0172
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1922 | OK | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dysphagia Specialists, PLLC | Past | Accepting new patients | |
| Stillwater Speech-Language Services | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Speech-Language Pathologist
- Stillwater, OK
- NPI 1356746184
-
- Speech-Language Pathologist
- Stillwater, OK
- NPI 1104269562
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1522108800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1522108800000",
"number": "1144725524",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4514 CLASSEN CT",
"city": "STILLWATER",
"state": "OK",
"postal_code": "740751631",
"telephone_number": "405-780-0172"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "814 S WALNUT ST",
"city": "STILLWATER",
"state": "OK",
"postal_code": "740744225",
"telephone_number": "405-377-8255"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEACH",
"first_name": "LARA",
"middle_name": "VICTORIA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-03-27",
"last_updated": "2018-03-27",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "OK",
"license": "1922",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Stillwater, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.