Basic Information
| Provider Information | |||||||||
| NPI: | 1326344250 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCLAUGHLIN | ||||||||
| FirstName: | LEESA | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | LEESA MCLAUGHLIN | ||||||||
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| OtherLastName: | MCLAUGHLIN | ||||||||
| OtherFirstName: | LEESA | ||||||||
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| OtherCredential: | LEESA MCLAUGHLIN | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 26 VINCENT ST | ||||||||
| Address2: | |||||||||
| City: | WHITMAN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023822221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172912582 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 164 PARKINGWAY | ||||||||
| Address2: | |||||||||
| City: | QUINCY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021695020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177734222 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2011 | ||||||||
| LastUpdateDate: | 02/10/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 7612 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.