Provider Demographics
NPI:1104971944
Name:LEOTAUD, JOAN M
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:M
Last Name:LEOTAUD
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 1:2777 SPICEBUSH LOOP
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-6431
Mailing Address - Country:US
Mailing Address - Phone:407-429-4994
Mailing Address - Fax:321-256-5082
Practice Address - Street 1:2777 SPICEBUSH LOOP
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32712-6431
Practice Address - Country:US
Practice Address - Phone:407-429-4994
Practice Address - Fax:321-256-5082
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL690399196Medicaid