Healthcare Provider Details

I. General information

NPI: 1003707126
Provider Name (Legal Business Name): NEW LEAF RECREATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2025
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 E COLLINS RD
FORT WAYNE IN
46825-5302
US

IV. Provider business mailing address

104 E COLLINS RD
FORT WAYNE IN
46825-5302
US

V. Phone/Fax

Practice location:
  • Phone: 260-267-5425
  • Fax:
Mailing address:
  • Phone: 260-267-5425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number
License Number State

VIII. Authorized Official

Name: TAYLOR STIEB
Title or Position: CO-OWNER/RECREATIONAL THERAPIST
Credential:
Phone: 419-509-4697