Healthcare Provider Details

I. General information

NPI: 1063579720
Provider Name (Legal Business Name): LEILANIE DAO OT/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 11/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30322 ESPERANZA SUITE A
RANCHO SANTA MARGARITA CA
92688-2137
US

IV. Provider business mailing address

20996 BAKE PKWY SUITE 106
LAKE FOREST CA
92630-2169
US

V. Phone/Fax

Practice location:
  • Phone: 949-600-5437
  • Fax:
Mailing address:
  • Phone: 949-600-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number7446
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225XF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapist
License Number7446
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: