Provider Demographics
NPI:1235323056
Name:LECEA, JUAN MARTIN JR (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:MARTIN
Last Name:LECEA
Suffix:JR
Gender:M
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 1:12436 VANCE JACKSON RD APT 1334
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-5995
Mailing Address - Country:US
Mailing Address - Phone:956-645-7029
Mailing Address - Fax:
Practice Address - Street 1:700 N. COLORADO BOULEVARD
Practice Address - Street 2:#318
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-4036
Practice Address - Country:US
Practice Address - Phone:866-399-2990
Practice Address - Fax:866-906-6331
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111873225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist