Provider Demographics
NPI:1699907808
Name:LEETIAN, NINO RICHIE CHIANG (OT)
Entity type:Individual
Prefix:MR
First Name:NINO RICHIE
Middle Name:CHIANG
Last Name:LEETIAN
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3614 CARROLLWOOD PLACE CIR
Mailing Address - Street 2:APT. 202
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-3070
Mailing Address - Country:US
Mailing Address - Phone:706-980-1864
Mailing Address - Fax:
Practice Address - Street 1:7030 EVERGREEN WOODS TRL
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34608-1305
Practice Address - Country:US
Practice Address - Phone:352-610-4475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004476225XG0600X
FLOT14185225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology