Healthcare Provider Details

I. General information

NPI: 1750687026
Provider Name (Legal Business Name): LEANA JEAN KOLBECK OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2011
Last Update Date: 02/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 8TH AVE APT #1005
SEATTLE WA
98104-1225
US

IV. Provider business mailing address

910 8TH AVE APT #1005
SEATTLE WA
98104-1225
US

V. Phone/Fax

Practice location:
  • Phone: 602-377-2283
  • Fax:
Mailing address:
  • Phone: 602-377-2283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License NumberOT 60113755
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: