Provider Demographics
NPI:1013384163
Name:LEON, NANCY (OT)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:LEON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 SHADY OAKS TRL
Mailing Address - Street 2:
Mailing Address - City:LIBERTY HILL
Mailing Address - State:TX
Mailing Address - Zip Code:78642-3945
Mailing Address - Country:US
Mailing Address - Phone:512-771-4219
Mailing Address - Fax:
Practice Address - Street 1:112 SHADY OAKS TRL
Practice Address - Street 2:
Practice Address - City:LIBERTY HILL
Practice Address - State:TX
Practice Address - Zip Code:78642-3945
Practice Address - Country:US
Practice Address - Phone:512-771-4219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-25
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000868172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist