Healthcare Provider Details

I. General information

NPI: 1174758551
Provider Name (Legal Business Name): CHRISTINA MARIE LEUZZO OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2009
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 NEW YORK AVE
SUPERIOR WI
54880-2008
US

IV. Provider business mailing address

242 FREEMAN RD
CLOQUET MN
55720-9417
US

V. Phone/Fax

Practice location:
  • Phone: 715-394-5591
  • Fax:
Mailing address:
  • Phone: 218-879-9315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number3603-026
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number102222
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: