Healthcare Provider Details

I. General information

NPI: 1063839827
Provider Name (Legal Business Name): LEIGH OBIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2014
Last Update Date: 03/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5462 MONTGOMERY SQUARE DR
KETTERING OH
45440-2933
US

IV. Provider business mailing address

5462 MONTGOMERY SQUARE DR
KETTERING OH
45440-2933
US

V. Phone/Fax

Practice location:
  • Phone: 937-329-1051
  • Fax:
Mailing address:
  • Phone: 937-329-1051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License NumberRN.382582
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN.382582
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: