Provider Demographics
NPI:1427821594
Name:BOTE, LEON ZERO
Entity type:Individual
Prefix:MR
First Name:LEON
Middle Name:ZERO
Last Name:BOTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JANELLE
Other - Middle Name:LYNN
Other - Last Name:CHADWICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:367 DUMBARTON BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-1732
Mailing Address - Country:US
Mailing Address - Phone:440-269-9779
Mailing Address - Fax:
Practice Address - Street 1:14600 DETROIT AVE APT 817
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-4227
Practice Address - Country:US
Practice Address - Phone:440-269-9779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSL800162172A00000X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No172A00000XOther Service ProvidersDriver