Provider Demographics
NPI:1790300481
Name:ABBOTT, LEA MARIE
Entity Type:Individual
Prefix:
First Name:LEA
Middle Name:MARIE
Last Name:ABBOTT
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 1:1545 GATEHOUSE CIR N APT 204
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-2967
Mailing Address - Country:US
Mailing Address - Phone:719-502-1608
Mailing Address - Fax:
Practice Address - Street 1:1545 GATEHOUSE CIR N APT 204
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-2967
Practice Address - Country:US
Practice Address - Phone:719-502-1608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-09
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No376J00000XNursing Service Related ProvidersHomemaker