Provider Demographics
NPI:1215252531
Name:LEONARD, PAUL BRYAN (OTR,L, CLT)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:BRYAN
Last Name:LEONARD
Suffix:
Gender:M
Credentials:OTR,L, CLT
Other - Prefix:MR
Other - First Name:PAUL
Other - Middle Name:BRYAN
Other - Last Name:JORDAN-LEONARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L,CLT
Mailing Address - Street 1:3895 OLD VINEYARD RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-4809
Mailing Address - Country:US
Mailing Address - Phone:336-283-9174
Mailing Address - Fax:336-283-9174
Practice Address - Street 1:3895 OLD VINEYARD RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104-4809
Practice Address - Country:US
Practice Address - Phone:336-283-9174
Practice Address - Fax:336-283-9174
Is Sole Proprietor?:No
Enumeration Date:2010-03-30
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1029225X00000X
NC9348225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist