1366917643 NPI number — DINA ILIANA LEEMAN OTR/L, MS, CBIS, LSV

Table of content: DINA ILIANA LEEMAN OTR/L, MS, CBIS, LSV (NPI 1366917643)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366917643 NPI number — DINA ILIANA LEEMAN OTR/L, MS, CBIS, LSV

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEEMAN
Provider First Name:
DINA
Provider Middle Name:
ILIANA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OTR/L, MS, CBIS, LSV
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366917643
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/12/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11 LONGWOOD AVE PH 3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLINE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02446-5281
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-307-1014
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
51 WATER ST STE 205
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATERTOWN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02472-4611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-774-8300
Provider Business Practice Location Address Fax Number:
617-744-6218
Provider Enumeration Date:
10/12/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225XN1300X , with the licence number:  12806 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com