Provider Demographics
NPI:1588015242
Name:LEONARD, SARAH JANE (LAT, ATC, OTC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:JANE
Last Name:LEONARD
Suffix:
Gender:F
Credentials:LAT, ATC, OTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1801
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:ME
Mailing Address - Zip Code:04039-1801
Mailing Address - Country:US
Mailing Address - Phone:207-730-3237
Mailing Address - Fax:
Practice Address - Street 1:10 LIBBY HILL RD
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:ME
Practice Address - Zip Code:04039-9712
Practice Address - Country:US
Practice Address - Phone:207-657-9311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAT497246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other