Provider Demographics
NPI:1376674846
Name:LEONARD, STEFANIE (MA, OTR/L)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:
Last Name:LEONARD
Suffix:
Gender:F
Credentials:MA, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3691 SILVER OAK CT
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-8689
Mailing Address - Country:US
Mailing Address - Phone:360-756-2255
Mailing Address - Fax:
Practice Address - Street 1:400 SEQUOIA DR STE 120
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-7634
Practice Address - Country:US
Practice Address - Phone:360-752-1511
Practice Address - Fax:360-752-1551
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00004375225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV003402016Medicaid
NV382617193OtherTAX ID NUMBER