Provider Demographics
NPI:1063672954
Name:LEONARD, TAMMY (OT)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:LEONARD
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 1:333 E WASHINGTON ST
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-2585
Mailing Address - Country:US
Mailing Address - Phone:262-335-4545
Mailing Address - Fax:262-335-6827
Practice Address - Street 1:333 E WASHINGTON ST
Practice Address - Street 2:SUITE 2000
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-2585
Practice Address - Country:US
Practice Address - Phone:262-335-4545
Practice Address - Fax:262-335-6827
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI263-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40728800Medicaid