Provider Demographics
NPI:1699988659
Name:LEONARD, LAKEESHA NICOLE (ATC)
Entity type:Individual
Prefix:MRS
First Name:LAKEESHA
Middle Name:NICOLE
Last Name:LEONARD
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8361 BRICKSHIRE
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-8024
Mailing Address - Country:US
Mailing Address - Phone:614-448-2454
Mailing Address - Fax:
Practice Address - Street 1:DENISON UNIVERSITY PHYSICAL EDUCATION DEPARTMENT
Practice Address - Street 2:200 LIVINGSTON DR
Practice Address - City:GRANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43023
Practice Address - Country:US
Practice Address - Phone:740-587-6488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT0025632255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer