Individual
JACKIE LEONARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
1 MEDICAL CENTER DRIVE, MORGANTOWN, WV 26506
(304) 598-4118
Mailing address
477 TYRONE AVERY RD, MORGANTOWN, WV 26508-4198
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
C1448
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810005863
—
WV
Enumeration date
12/01/2006
Last updated
07/08/2007
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