Basic Information
| Provider Information | |||||||||
| NPI: | 1285399121 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEONARD | ||||||||
| FirstName: | SEAN | ||||||||
| MiddleName: | PATRICK | ||||||||
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| Credential: | OTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3809 W CHESTER PIKE STE 150 | ||||||||
| Address2: | |||||||||
| City: | NEWTOWN SQUARE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190730259 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4843569401 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1161 MCDERMOTT DR | ||||||||
| Address2: | |||||||||
| City: | WEST CHESTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193804064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4843569401 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2021 | ||||||||
| LastUpdateDate: | 11/05/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 225700000X | 01 | PA | TAXONOMY | OTHER |