Healthcare Provider Details

I. General information

NPI: 1336198738
Provider Name (Legal Business Name): JAMIE M. MENDOZA OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAMIE M. LEESER

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 11/04/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4110 BRIARGATE PKWY STE 300
COLORADO SPRINGS CO
80920-7837
US

IV. Provider business mailing address

1120 TREK TRAIL HTS APT 208
COLORADO SPRINGS CO
80921-4515
US

V. Phone/Fax

Practice location:
  • Phone: 719-632-7669
  • Fax: 719-632-0088
Mailing address:
  • Phone: 858-922-5402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT5817
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: