Healthcare Provider Details

I. General information

NPI: 1003852138
Provider Name (Legal Business Name): JEFFREY DAVID LEONE OT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

193 GLADES RD
BEREA KY
40403-1369
US

IV. Provider business mailing address

PO BOX 911148
LEXINGTON KY
40591-1148
US

V. Phone/Fax

Practice location:
  • Phone: 859-986-1055
  • Fax: 859-986-1002
Mailing address:
  • Phone: 859-278-2121
  • Fax: 859-276-2795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberR1468
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: