Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT 1818 | TN |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 13817 | NC |
NPI | 1003268798 |
---|---|
Provider Name | Rafael Antonio Leon |
First Address | Johnson City, TN 37601-2635 |
Second Address | Johnson City, TN 37601-2635 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2016 |
Last Update Date | 19/03/2021 |