Basic Information
Provider Information | |||||||||
NPI: | 1497986996 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LEASURE | ||||||||
FirstName: | DEBORAH | ||||||||
MiddleName: | J | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | H.A.S, BC-HIS, ACA | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 231 DEL PRADO BLVD SOUTH #5 | ||||||||
Address2: |   | ||||||||
City: | CAPE CORAL | ||||||||
State: | FL | ||||||||
PostalCode: | 33990 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2397728101 | ||||||||
FaxNumber: | 2397720079 | ||||||||
Practice Location | |||||||||
Address1: | 544 ARTHUR GODFREY RD | ||||||||
Address2: |   | ||||||||
City: | MIAMI BEACH | ||||||||
State: | FL | ||||||||
PostalCode: | 331403510 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3055346333 | ||||||||
FaxNumber: | 3055346913 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/31/2009 | ||||||||
LastUpdateDate: | 10/21/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | AS3471 | FL | Y |   | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |   |
No ID Information.