Provider Demographics
NPI:1720370885
Name:HOUSEHOLDER, LEANNE (COTA/KL)
Entity Type:Individual
Prefix:
First Name:LEANNE
Middle Name:
Last Name:HOUSEHOLDER
Suffix:
Gender:F
Credentials:COTA/KL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTONVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44490-9705
Mailing Address - Country:US
Mailing Address - Phone:330-420-5349
Mailing Address - Fax:
Practice Address - Street 1:339 E MAPLE ST
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-2593
Practice Address - Country:US
Practice Address - Phone:330-498-8239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-09
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747P1801X
OHOTA. 03307224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant