Individual
LEIA MANKTELOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
725 WELCH RD, PALO ALTO, CA 94304-1601
(650) 736-2000
Mailing address
725 WELCH RD, PALO ALTO, CA 94304-1601
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
13600
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05330
—
CA
Enumeration date
06/17/2014
Last updated
06/17/2014
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