Provider Demographics
NPI:1659016251
Name:LEASURE, ARIEL DIANE (OTR)
Entity Type:Individual
Prefix:
First Name:ARIEL
Middle Name:DIANE
Last Name:LEASURE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2081 WHITMAN WAY APT 424
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-4087
Mailing Address - Country:US
Mailing Address - Phone:814-490-6280
Mailing Address - Fax:
Practice Address - Street 1:33 MATEO AVE
Practice Address - Street 2:
Practice Address - City:MILLBRAE
Practice Address - State:CA
Practice Address - Zip Code:94030-2037
Practice Address - Country:US
Practice Address - Phone:650-689-5784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-28
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225X00000X
CA23670225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty