MEDICARE: RAFAEL ANTONIO LEON OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OT 1818	TN
2	225XP0019X	Physical Rehabilitation Occupational Therapist	13817	NC

General Provider Information

NPI Number	:	1003268798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAFAEL ANTONIO LEON OTR/L

Provider Business Mailing Address
First Line	:	1507 WOODLAND AVE
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-2635
Country	:	US
Telephone Number	:	423-440-5782
Fax Number	:

Provider Business Practice Location Address
First Line	:	1507 WOODLAND AVE
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-2635
Country	:	US
Telephone Number	:	423-440-5782
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2016
Last Update Date	:	03/19/2021

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