Provider Demographics
NPI:1073386850
Name:LEONESIO, JENNIFER LEA (MS)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LEA
Last Name:LEONESIO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:LEA
Other - Last Name:BOETTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:6500 ARAPAHOE RD
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-1407
Mailing Address - Country:US
Mailing Address - Phone:720-561-1010
Mailing Address - Fax:
Practice Address - Street 1:6500 ARAPAHOE RD
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1407
Practice Address - Country:US
Practice Address - Phone:720-561-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0001949225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist