Provider Demographics
NPI:1346788809
Name:LEON, KATIE (MS, OTR/L, CBIS)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:LEON
Suffix:
Gender:F
Credentials:MS, OTR/L, CBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10102 OVERLOOK DRIVE
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54937
Mailing Address - Country:US
Mailing Address - Phone:501-472-7509
Mailing Address - Fax:
Practice Address - Street 1:10102 OVERLOOK DRIVE
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54937
Practice Address - Country:US
Practice Address - Phone:501-472-7509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-05
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6979-26225X00000X
NJ46TR00754900225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist