Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT12466 | CA |
NPI | 1023381795 |
---|---|
Provider Name | Miss Cleo Le |
First Address | Saint Paul, MN 55117-5416 |
Second Address | Hanford, CA 93230-5643 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2012 |
Last Update Date | 10/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01632469 | MEDICAL ASSISTANCE (01) | MN |