Provider Demographics
NPI:1225670441
Name:LEONARD, BRITT D (COTA/L)
Entity Type:Individual
Prefix:
First Name:BRITT
Middle Name:D
Last Name:LEONARD
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 SOUTH SECOND STREET
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62545
Mailing Address - Country:US
Mailing Address - Phone:217-741-6908
Mailing Address - Fax:
Practice Address - Street 1:3130 CHATHAM RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-5369
Practice Address - Country:US
Practice Address - Phone:217-741-6908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-09
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL398384224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant