Healthcare Provider Details

I. General information

NPI: 1598599185
Provider Name (Legal Business Name): LEONEL MOTTO NTUI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2024
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 DELAWARE DR
DELAWARE OH
43015-3695
US

IV. Provider business mailing address

161 DELAWARE DR
DELAWARE OH
43015-3695
US

V. Phone/Fax

Practice location:
  • Phone: 614-695-1489
  • Fax:
Mailing address:
  • Phone: 614-695-1489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License NumberU707090
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberU707090
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: