Provider Demographics
NPI:1023381795
Name:LE, CLEO (OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:CLEO
Middle Name:
Last Name:LE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 PARK ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55117-5416
Mailing Address - Country:US
Mailing Address - Phone:612-876-1468
Mailing Address - Fax:
Practice Address - Street 1:851 LESLIE LN
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-5643
Practice Address - Country:US
Practice Address - Phone:559-582-4414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT12466225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN01632469OtherMEDICAL ASSISTANCE