Provider Demographics
NPI:1891750030
Name:KARAGOSIAN, LEANNE (LATC)
Entity Type:Individual
Prefix:
First Name:LEANNE
Middle Name:
Last Name:KARAGOSIAN
Suffix:
Gender:F
Credentials:LATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 HEATHER DR
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-1516
Mailing Address - Country:US
Mailing Address - Phone:508-269-3277
Mailing Address - Fax:
Practice Address - Street 1:18 SOUTH ST
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-2435
Practice Address - Country:US
Practice Address - Phone:781-659-8811
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10782255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer