Provider Demographics
NPI:1073977831
Name:LEEPER, AILISH C (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:AILISH
Middle Name:C
Last Name:LEEPER
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 1:802 W DRAKE RD
Mailing Address - Street 2:SUITE 145
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-5558
Mailing Address - Country:US
Mailing Address - Phone:970-667-6111
Mailing Address - Fax:
Practice Address - Street 1:802 W DRAKE RD
Practice Address - Street 2:SUITE 145
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-5558
Practice Address - Country:US
Practice Address - Phone:970-667-6111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-07
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000630225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist