Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OTA.007028 | OH |
NPI | 1013573393 |
---|---|
Provider Name | Leah Marie Tolley |
First Address | North Canton, OH 44720-2593 |
Second Address | Canal Fulton, OH 44614-9121 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2019 |
Last Update Date | 13/05/2019 |