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NPI Code Detail

MEDICARE: ARIEL DIANE LEASURE OTR

MEDICARE: ARIEL DIANE LEASURE OTR
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
1225X00000XOccupational TherapistCA
2225X00000XOccupational Therapist23670CA

General Provider Information

NPI Number : 1659016251
Entity Type Code : Individual
Provider Name (Legal Business Name) : ARIEL DIANE LEASURE OTR
Provider Business Mailing Address
First Line : 2081 WHITMAN WAY APT 424
Second Line :
City : SAN BRUNO
State : CA
Zip : 94066-4087
Country : US
Telephone Number : 814-490-6280
Fax Number :
Provider Business Practice Location Address
First Line : 33 MATEO AVE
Second Line :
City : MILLBRAE
State : CA
Zip : 94030-2037
Country : US
Telephone Number : 650-689-5784
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/28/2022
Last Update Date : 05/10/2022

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Directions to “ ARIEL DIANE LEASURE OTR” Practice Location

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