Provider Demographics
NPI:1689836884
Name:ROY, LEO JOSEPH (COTA)
Entity Type:Individual
Prefix:MR
First Name:LEO
Middle Name:JOSEPH
Last Name:ROY
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 LONGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:STELLA
Mailing Address - State:NC
Mailing Address - Zip Code:28582-9671
Mailing Address - Country:US
Mailing Address - Phone:910-326-1512
Mailing Address - Fax:
Practice Address - Street 1:122 LONGWOOD DR
Practice Address - Street 2:
Practice Address - City:STELLA
Practice Address - State:NC
Practice Address - Zip Code:28582-9671
Practice Address - Country:US
Practice Address - Phone:910-326-1512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-28
Last Update Date:2008-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6781224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant