Provider Demographics
NPI:1669165734
Name:LEONHARDT, KELSY PARADISE
Entity type:Individual
Prefix:
First Name:KELSY
Middle Name:PARADISE
Last Name:LEONHARDT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6914 PLEASANT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WI
Mailing Address - Zip Code:53024-9627
Mailing Address - Country:US
Mailing Address - Phone:262-305-9233
Mailing Address - Fax:
Practice Address - Street 1:6914 PLEASANT VALLEY RD
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WI
Practice Address - Zip Code:53024-9627
Practice Address - Country:US
Practice Address - Phone:262-305-9233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist