Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | AA334425 | CO |
N | 225XH1200X | Occupational Therapist - Hand | AA334425 | CO |
NPI | 1013093020 |
---|---|
Provider Name | Mary L Leone |
First Address | Vail, CO 81658-7520 |
Second Address | Vail, CO 81657 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2006 |
Last Update Date | 09/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1235180308 | (05) | CO |
17408776 | (05) | CO |