Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 31007598A | IN |
NPI | 1003572439 |
---|---|
Provider Name | Lauren Leopold |
First Address | Fort Wayne, IN 46825-5042 |
Second Address | Fort Wayne, IN 46825-5042 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2021 |
Last Update Date | 10/11/2021 |