Provider Demographics
NPI:1881315232
Name:LOVE, LEIA
Entity type:Individual
Prefix:
First Name:LEIA
Middle Name:
Last Name:LOVE
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 1:2950 W MARKET ST STE K
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3614
Mailing Address - Country:US
Mailing Address - Phone:330-338-1373
Mailing Address - Fax:
Practice Address - Street 1:2950 W MARKET ST STE K
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3614
Practice Address - Country:US
Practice Address - Phone:330-338-1373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-05
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X, 1744P3200X, 374700000X, 246Z00000X
OHCOSI027863224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
No174400000XOther Service ProvidersSpecialist
No1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty
No374700000XNursing Service Related ProvidersTechnicianGroup - Single Specialty