Provider Demographics
NPI:1750864856
Name:STEVENS, LESA HOGEBOOM (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:LESA
Middle Name:HOGEBOOM
Last Name:STEVENS
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:LESA
Other - Middle Name:MARIE
Other - Last Name:HOGEBOOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:391 TAYLOR BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-2289
Mailing Address - Country:US
Mailing Address - Phone:925-608-6587
Mailing Address - Fax:
Practice Address - Street 1:391 TAYLOR BLVD STE 100
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-2289
Practice Address - Country:US
Practice Address - Phone:925-608-6550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18731225X00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist