Provider Demographics
NPI:1851782650
Name:LEONARD, STEPHANIE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:
Last Name:LEONARD
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 CLARKE CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-6936
Mailing Address - Country:US
Mailing Address - Phone:704-947-8050
Mailing Address - Fax:
Practice Address - Street 1:400 CENTRE ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02458-2094
Practice Address - Country:US
Practice Address - Phone:704-947-8050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-15
Last Update Date:2015-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6622174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist