Individual
LEIANNA WICHOWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
5110 E DALLAS PL, BROKEN ARROW, OK 74014-2687
(618) 975-3047
Mailing address
5110 E DALLAS PL, BROKEN ARROW, OK 74014-2687
(618) 975-3047
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2007004044
MO
225X00000X
Occupational Therapist
OT13899
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
891785000
—
FL
Enumeration date
12/11/2009
Last updated
12/11/2009
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