Provider Demographics
NPI:1326513482
Name:LECLERC, JOHN BRIAN (OTR/L)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:BRIAN
Last Name:LECLERC
Suffix:
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 1:816 W MIDWAY DR
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:ND
Mailing Address - Zip Code:58237-7501
Mailing Address - Country:US
Mailing Address - Phone:701-352-4545
Mailing Address - Fax:
Practice Address - Street 1:816 W MIDWAY DR
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:ND
Practice Address - Zip Code:58237-7501
Practice Address - Country:US
Practice Address - Phone:701-352-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-04
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN105770225X00000X
ND1648225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist