Individual
JACLYN RENEE LIESKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
621 S 4TH ST, LE SUEUR, MN 56058-2203
(507) 665-8689
Mailing address
37759 280TH ST, HENDERSON, MN 56044-3502
(507) 380-6704
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
200079
MN
Other
Enumeration date
11/04/2024
Last updated
11/04/2024
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