Individual
MISS CLEO LE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
851 LESLIE LN, HANFORD, CA 93230-5643
(559) 582-4414
Mailing address
940 PARK ST, SAINT PAUL, MN 55117-5416
(612) 876-1468
Taxonomy
Speciality
Code
Description
License number
State
225XP0019X
Physical Rehabilitation Occupational Therapist
Primary
OT12466
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01632469
MEDICAL ASSISTANCE
MN
Enumeration date
02/10/2012
Last updated
02/10/2012
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