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Individual

THEODORE LEONARD

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
1448 GAILWOOD CIR N, JACKSONVILLE, FL 32218-5286
(090) 469-7646
Mailing address
1448 GAILWOOD CIR N, JACKSONVILLE, FL 32218-5286
(904) 697-6464

Taxonomy

Speciality
Code
Description
License number
State
225XR0403X
Driving and Community Mobility Occupational Therapist
Primary
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
84-4498219
TRANPORTAION DRIVER
FL
05
84-4498219
FL
Enumeration date
01/29/2020
Last updated
01/29/2020
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