Individual
LEAH MASHBURN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MOT/ OTR,L
Contact information
Practice address
1605 S EUCALYPTUS AVE STE 200, BROKEN ARROW, OK 74012-5996
(918) 608-1212
(918) 289-2606
Mailing address
1605 S EUCALYPTUS AVE STE 200, BROKEN ARROW, OK 74012-5996
(918) 608-1212
(918) 289-2606
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
5485
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5485
OKLAHOMA STATE BOARD OF MEDICAL LICENSURE AND SUPERVISION
OK
Enumeration date
09/22/2020
Last updated
11/27/2023
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