Provider Demographics
NPI:1184790958
Name:BIDTAH, LEAH ANN (OTRL)
Entity type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:ANN
Last Name:BIDTAH
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:MISS
Other - First Name:LEAH
Other - Middle Name:ANN
Other - Last Name:HODGSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:142 BRIARCLIFF RD
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-1060
Mailing Address - Country:US
Mailing Address - Phone:716-200-0626
Mailing Address - Fax:
Practice Address - Street 1:2565 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-1939
Practice Address - Country:US
Practice Address - Phone:716-871-9883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010133-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY010133-1OtherSTATE LICENSE NUMBER