Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | R1468 | KY |
NPI | 1003852138 |
---|---|
Provider Name | Mr. Jeffrey David Leone |
First Address | Lexington, KY 40591-1148 |
Second Address | Berea, KY 40403-1369 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2006 |
Last Update Date | 08/07/2007 |