Individual
JACOB VANLEEUWEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5757 W THUNDERBIRD RD, SUITE E-465, GLENDALE, AZ 85306-4641
(602) 843-9945
(602) 843-8775
Mailing address
690 N COFCO CENTER CT, STE 260, PHOENIX, AZ 85008-6462
(602) 279-6905
(602) 279-6934
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2197
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
885676
—
AZ
Enumeration date
09/11/2006
Last updated
09/13/2011
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