Provider Demographics
NPI:1629610209
Name:LEBLOND, GREGORY N (COTA/L)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:N
Last Name:LEBLOND
Suffix:
Gender:M
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 1:175 BLUEBERRY LN
Mailing Address - Street 2:
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03246-2918
Mailing Address - Country:US
Mailing Address - Phone:603-524-3340
Mailing Address - Fax:
Practice Address - Street 1:175 BLUEBERRY LN
Practice Address - Street 2:
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-2918
Practice Address - Country:US
Practice Address - Phone:603-542-3340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0819224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant