MEDICARE: CHRISTINE GRACE LEONARD M.S., 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	9703	MA

General Provider Information

NPI Number	:	1225343205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE GRACE LEONARD M.S., OTR/L

Provider Business Mailing Address
First Line	:	238 COLUMBIA ST
Second Line	:	APT 1S
City	:	CAMBRIDGE
State	:	MA
Zip	:	02139-1532
Country	:	US
Telephone Number	:	617-784-2902
Fax Number	:

Provider Business Practice Location Address
First Line	:	850 CAMBRIDGE ST
Second Line	:
City	:	CAMBRIDGE
State	:	MA
Zip	:	02141-1402
Country	:	US
Telephone Number	:	617-349-6540
Fax Number	:

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

Provider Enumeration Date	:	08/13/2010
Last Update Date	:	02/05/2014

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