Healthcare Provider Details

I. General information

NPI: 1841374451
Provider Name (Legal Business Name): LESLIE JOAN REIMANN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8363 W ANTELOPE DR
PEORIA AZ
85383-4602
US

IV. Provider business mailing address

8363 W ANTELOPE DR
PEORIA AZ
85383-4602
US

V. Phone/Fax

Practice location:
  • Phone: 623-566-8459
  • Fax: 623-566-8459
Mailing address:
  • Phone: 623-566-8459
  • Fax: 623-566-8459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number2073
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: