Individual
JACQUELINE LEON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2130 ANDERSON MILL RD, AUSTELL, GA 30106-1806
(770) 941-8813
Mailing address
2981 HOLLOW LN, POWDER SPRINGS, GA 30127-1864
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA002300
GA
Other
Enumeration date
09/20/2018
Last updated
09/20/2018
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