Individual
LEA CLEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
2525 E FIRST ST, FORT MYERS, FL 33901-2465
(239) 332-5371
Mailing address
19641 BURGUNDY FARMS RD, ESTERO, FL 33928-9509
(239) 992-2794
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT 13958
FL
Other
Enumeration date
01/26/2007
Last updated
11/11/2010
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