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General NPI Number Information
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NPI Number | 1154145928
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Entity Type | Organization
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Legal Business Name | LEAP FORWARD OT LLC
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Dates
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Enumeration Date | 11/08/2024
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 852 CEDAR GROVE DR
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City | TIPP CITY
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State | OH
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Zip | 45371-7587
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Country | US
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Telephone | 937-572-0873
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Fax |
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Provider Business Mailing Address
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Address Line | 852 CEDAR GROVE DR
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City | TIPP CITY
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State | OH
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Zip | 45371-7587
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MEGAN WITWER
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Credential | MOT
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Telephone | 937-572-0873
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State |
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