Provider Demographics
NPI:1801257068
Name:LEEGE, TAYLOR LEE
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:LEE
Last Name:LEEGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5311 E SUPERIOR ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55804-2423
Mailing Address - Country:US
Mailing Address - Phone:218-391-9328
Mailing Address - Fax:
Practice Address - Street 1:502 EAST SECOND STREET
Practice Address - Street 2:ESSENTIA HEALTH DULUTH
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-1951
Practice Address - Country:US
Practice Address - Phone:218-786-4150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist