Provider Demographics
NPI:1639820525
Name:KOTHEIMER, LEAH CHRISTINE
Entity Type:Individual
Prefix:MISS
First Name:LEAH
Middle Name:CHRISTINE
Last Name:KOTHEIMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11175 SPERRY RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44026-1534
Mailing Address - Country:US
Mailing Address - Phone:440-371-4733
Mailing Address - Fax:
Practice Address - Street 1:11175 SPERRY RD
Practice Address - Street 2:
Practice Address - City:CHESTERLAND
Practice Address - State:OH
Practice Address - Zip Code:44026-1534
Practice Address - Country:US
Practice Address - Phone:440-371-4733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide