Provider Demographics
NPI:1891378691
Name:NEAD, LEA GRACE (MS, OTR/L, CBIS)
Entity Type:Individual
Prefix:
First Name:LEA
Middle Name:GRACE
Last Name:NEAD
Suffix:
Gender:F
Credentials:MS, OTR/L, CBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 W PARK AVE STE 211
Mailing Address - Street 2:
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-8526
Mailing Address - Country:US
Mailing Address - Phone:732-918-4848
Mailing Address - Fax:
Practice Address - Street 1:15 8TH ST
Practice Address - Street 2:
Practice Address - City:NEW PROVIDENCE
Practice Address - State:NJ
Practice Address - Zip Code:07974-2209
Practice Address - Country:US
Practice Address - Phone:908-500-9480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00672900225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist