Provider Demographics
NPI:1144592320
Name:THIBO, LEANN MARIE (MS, ATC)
Entity Type:Individual
Prefix:MRS
First Name:LEANN
Middle Name:MARIE
Last Name:THIBO
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:MISS
Other - First Name:LEANN
Other - Middle Name:MARIE
Other - Last Name:GILLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, ATC
Mailing Address - Street 1:2452 THEISS RD
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-3045
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4687 WYOGA LAKE RD
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-1011
Practice Address - Country:US
Practice Address - Phone:330-929-0575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-02
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT0045222255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer