MEDICARE: THERESA LETO

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	225X00000X	Occupational Therapist	31004072A	IN

General Provider Information

NPI Number	:	1184586992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA LETO

Provider Business Mailing Address
First Line	:	3030 LAKE AVE STE 27
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46805-5428
Country	:	US
Telephone Number	:	260-267-5631
Fax Number	:

Provider Business Practice Location Address
First Line	:	3030 LAKE AVE STE 27
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46805-5428
Country	:	US
Telephone Number	:	260-267-5631
Fax Number	:

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

Provider Enumeration Date	:	12/01/2025
Last Update Date	:	12/01/2025

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Directions to “ THERESA LETO ” Practice Location

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