Healthcare Provider Details

I. General information

NPI: 1780731984
Provider Name (Legal Business Name): MRS. LEANN MARIE JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6083 STATE RD
PARMA OH
44134-3769
US

IV. Provider business mailing address

6083 STATE RD
PARMA OH
44134-3769
US

V. Phone/Fax

Practice location:
  • Phone: 440-885-4015
  • Fax: 440-885-3538
Mailing address:
  • Phone: 440-885-4015
  • Fax: 440-885-3538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: