Provider Demographics
NPI:1710404942
Name:LE, KALIN W (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:KALIN
Middle Name:W
Last Name:LE
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:KALIN
Other - Middle Name:W
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:980 ROOSEVELT STE 100
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-3670
Mailing Address - Country:US
Mailing Address - Phone:949-333-6400
Mailing Address - Fax:
Practice Address - Street 1:980 ROOSEVELT STE 100
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92620-3670
Practice Address - Country:US
Practice Address - Phone:949-333-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-28
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17813225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist