MEDICARE: LEILA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0400X	Rehabilitation Clinic/Center	05618	OH

General Provider Information

NPI Number	:	1023430048
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEILA

Provider Business Mailing Address
First Line	:	1666 11TH ST
Second Line	:
City	:	CUYAHOGA FALLS
State	:	OH
Zip	:	44221-4514
Country	:	US
Telephone Number	:	330-524-7789
Fax Number	:

Provider Business Practice Location Address
First Line	:	1666 11TH ST
Second Line	:
City	:	CUYAHOGA FALLS
State	:	OH
Zip	:	44221-4514
Country	:	US
Telephone Number	:	330-524-7789
Fax Number	:

Authorized Official
Title or Position	:	HEAD
Name	:	MRS. LEILA ROLLINS
Credential	:	COTA/L
Telephone Number	:	330-524-7789

Provider Enumeration Date	:	01/09/2014
Last Update Date	:	01/09/2014

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Directions to “LEILA ” Practice Location

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