Basic Information
| Provider Information | |||||||||
| NPI: | 1194357053 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEAVELL | ||||||||
| FirstName: | KIRSTEN | ||||||||
| MiddleName: | D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 55 WILLOW ST | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 474487013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3172008846 | ||||||||
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| Practice Location | |||||||||
| Address1: | 55 WILLOW ST | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 474487013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8129886666 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2020 | ||||||||
| LastUpdateDate: | 02/09/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 31007090A. | IN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.