Provider Demographics
NPI:1568623783
Name:HOLLENBECK, LEA MARIE (OT/L)
Entity Type:Individual
Prefix:MRS
First Name:LEA
Middle Name:MARIE
Last Name:HOLLENBECK
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 DENNISON DR
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-4801
Mailing Address - Country:US
Mailing Address - Phone:636-222-2782
Mailing Address - Fax:
Practice Address - Street 1:235 DENNISON DR
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63021-4801
Practice Address - Country:US
Practice Address - Phone:636-222-2782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5960225X00000X
MO2007026641225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist