Provider Demographics
NPI:1386062016
Name:LEITZEL, NIKKI
Entity type:Individual
Prefix:
First Name:NIKKI
Middle Name:
Last Name:LEITZEL
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 1:948 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HEGINS
Mailing Address - State:PA
Mailing Address - Zip Code:17938-9386
Mailing Address - Country:US
Mailing Address - Phone:570-590-3631
Mailing Address - Fax:
Practice Address - Street 1:403 HAZLE TOWNSHIP BLVD
Practice Address - Street 2:
Practice Address - City:HAZLE TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18202-9661
Practice Address - Country:US
Practice Address - Phone:570-454-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-31
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP007831224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant