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General NPI Number Information
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NPI Number | 1003707126
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Entity Type | Organization
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Legal Business Name | NEW LEAF RECREATION, LLC
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Dates
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Enumeration Date | 07/15/2025
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Last Update Date | 09/09/2025
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Provider Practice Location Address
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Address Line | 104 E COLLINS RD
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City | FORT WAYNE
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State | IN
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Zip | 46825-5302
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Country | US
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Telephone | 260-267-5425
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Fax |
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Provider Business Mailing Address
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Address Line | 104 E COLLINS RD
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City | FORT WAYNE
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State | IN
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Zip | 46825-5302
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Country | US
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Telephone | 260-267-5425
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Fax |
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Authorized Official
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Title or Position | CO-OWNER/RECREATIONAL THERAPIST
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Name | TAYLOR STIEB
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Credential |
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Telephone | 419-509-4697
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225800000X
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Taxonomy Name | Recreation Therapist
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License Number |
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License Number State |
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