Provider Demographics
NPI:1881866820
Name:LESTARI, IRENE (OTR/L)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:LESTARI
Suffix:
Gender:F
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 1:2336 WINEPOL LOOP
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-6635
Mailing Address - Country:US
Mailing Address - Phone:408-547-7648
Mailing Address - Fax:
Practice Address - Street 1:2336 WINEPOL LOOP
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-6635
Practice Address - Country:US
Practice Address - Phone:408-547-7648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT7552225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics