Provider Demographics
NPI:1639719321
Name:LEIB, JODI RACHELLE (MA, RDT, CDP, CATP)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:RACHELLE
Last Name:LEIB
Suffix:
Gender:F
Credentials:MA, RDT, CDP, CATP
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:LEIB
Other - Last Name:CODEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, RDT, CDP, CATP
Mailing Address - Street 1:6725 DALY RD UNIT 251952
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48325-3280
Mailing Address - Country:US
Mailing Address - Phone:248-872-1101
Mailing Address - Fax:248-671-0337
Practice Address - Street 1:888 W BIG BEAVER RD STE 780
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4745
Practice Address - Country:US
Practice Address - Phone:248-880-6600
Practice Address - Fax:248-817-8458
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-09
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
No225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance TherapistGroup - Single Specialty
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation TherapistGroup - Single Specialty