MEDICARE: LESLEY ANNE TORDILLA DIMSON COTA/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Z00000X	Occupational Therapy Assistant	5297	CA

General Provider Information

NPI Number	:	1083290167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLEY ANNE TORDILLA DIMSON COTA/L

Provider Business Mailing Address
First Line	:	514 N OAKLAND AVE
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91101-1112
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	514 N OAKLAND AVE
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91101-1112
Country	:	US
Telephone Number	:	650-797-9442
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2021
Last Update Date	:	03/20/2021

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