Healthcare Provider Details

I. General information

NPI: 1457272403
Provider Name (Legal Business Name): KATANA LEASMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 STRONG RD
QUINCY FL
32351-5243
US

IV. Provider business mailing address

860 STRONG RD
QUINCY FL
32351-5243
US

V. Phone/Fax

Practice location:
  • Phone: 850-566-5029
  • Fax: 850-563-8488
Mailing address:
  • Phone: 850-566-5029
  • Fax: 850-563-8488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-2826123
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: