Provider Demographics
NPI:1780731984
Name:JOHNSON, LEANN MARIE
Entity type:Individual
Prefix:MRS
First Name:LEANN
Middle Name:MARIE
Last Name:JOHNSON
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 1:6083 STATE RD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-3769
Mailing Address - Country:US
Mailing Address - Phone:440-885-4015
Mailing Address - Fax:440-885-3538
Practice Address - Street 1:6083 STATE RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-3769
Practice Address - Country:US
Practice Address - Phone:440-885-4015
Practice Address - Fax:440-885-3538
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH100587OtherKAISER PERMANENTE
OH341425661-004OtherMEDICAL MUTUAL
OH6725208Medicaid
OH341425661-00OtherWORKERS COMP
OH6725208Medicaid