Healthcare Provider Details

I. General information

NPI: 1396344735
Provider Name (Legal Business Name): JESSICA ANNE LEER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2020
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 SENTRY PKWY E STE 200
BLUE BELL PA
19422-2319
US

IV. Provider business mailing address

736 CEDAR DR
PHOENIXVILLE PA
19460-3606
US

V. Phone/Fax

Practice location:
  • Phone: 267-802-1701
  • Fax:
Mailing address:
  • Phone: 215-272-2308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC017111
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOC017111
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: