Provider Demographics
NPI:1194359760
Name:LEHECKA, KYSSERIA KALCEY (OTD)
Entity Type:Individual
Prefix:
First Name:KYSSERIA
Middle Name:KALCEY
Last Name:LEHECKA
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4008 E 133RD PL
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80241-1504
Mailing Address - Country:US
Mailing Address - Phone:303-619-2532
Mailing Address - Fax:
Practice Address - Street 1:2100 SOLAR DR STE 204
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-2602
Practice Address - Country:US
Practice Address - Phone:805-765-4773
Practice Address - Fax:805-392-9975
Is Sole Proprietor?:No
Enumeration Date:2020-02-23
Last Update Date:2020-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT19186225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist