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General NPI Number Information
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NPI Number | 1902571409
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Entity Type | Individual
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Provider Name | ANDREW SCOTT LEATHERS OTD
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Gender | Male
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Dates
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Enumeration Date | 08/16/2021
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Last Update Date | 08/16/2021
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Provider Practice Location Address
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Address Line | 120 EASTGATE DR
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City | WASHINGTON
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State | IL
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Zip | 61571-9236
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Country | US
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Telephone | 309-423-3111
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Fax |
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Provider Business Mailing Address
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Address Line | 10723 N HONEYCREEK LN
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City | DUNLAP
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State | IL
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Zip | 61525-8736
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Country | US
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Telephone | 309-573-3197
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 056.014226
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License Number State | IL
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