Healthcare Provider Details

I. General information

NPI: 1154263929
Provider Name (Legal Business Name): LEANNE LACHICA GUTIERREZ OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14032 TICONDEROGA CT
FONTANA CA
92336-3518
US

IV. Provider business mailing address

14032 TICONDEROGA CT
FONTANA CA
92336-3518
US

V. Phone/Fax

Practice location:
  • Phone: 909-697-6796
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number26324
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: