MEDICARE: LEONA MARGARET PADDOCK

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	373H00000X	Day Training/Habilitation Specialist

General Provider Information

NPI Number	:	1528181807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEONA MARGARET PADDOCK

Provider Business Mailing Address
First Line	:	715 8TH ST
Second Line	:
City	:	COVINGTON
State	:	IN
Zip	:	47932-1419
Country	:	US
Telephone Number	:	765-793-2578
Fax Number	:	765-793-7540

Provider Business Practice Location Address
First Line	:	715 8TH ST
Second Line	:
City	:	COVINGTON
State	:	IN
Zip	:	47932-1419
Country	:	US
Telephone Number	:	765-793-2578
Fax Number	:	765-793-7540

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

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	07/08/2007

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Directions to “ LEONA MARGARET PADDOCK ” Practice Location

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