Provider Demographics
NPI:1902328719
Name:LEONARD, ANDREANA (COTA/L)
Entity Type:Individual
Prefix:
First Name:ANDREANA
Middle Name:
Last Name:LEONARD
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3214 TOWN BROOKE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-6610
Mailing Address - Country:US
Mailing Address - Phone:869-906-6777
Mailing Address - Fax:
Practice Address - Street 1:55 KONDRACKI LN
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-4951
Practice Address - Country:US
Practice Address - Phone:203-265-6771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-13
Last Update Date:2017-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1600224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant