Healthcare Provider Details

I. General information

NPI: 1144034794
Provider Name (Legal Business Name): MISS LEAH MAE HOMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2025
Last Update Date: 07/19/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 FLETCHER ST
ANN ARBOR MI
48109-1050
US

IV. Provider business mailing address

26 GOODERHAM DR
GEORGETOWN ONTARIO
L7G5R6
CA

V. Phone/Fax

Practice location:
  • Phone: 734-764-8320
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2601003254
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: