Individual
LEQUITTA FONTENOT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
551 W LANCASTER AVE, HAVERFORD, PA 19041-1419
(610) 525-4000
Mailing address
551 W LANCASTER AVE, HAVERFORD, PA 19041-1419
(610) 525-4000
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA 04145
OH
Other
Enumeration date
12/08/2009
Last updated
12/08/2009
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