Provider Demographics
NPI:1952866444
Name:DE LEON, STEFFI ELLEIN RIVERA (OT)
Entity Type:Individual
Prefix:MRS
First Name:STEFFI ELLEIN
Middle Name:RIVERA
Last Name:DE LEON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MISS
Other - First Name:STEFFI ELLEIN
Other - Middle Name:ESTABAS
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2840 CHANNEL REEF AVE
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-7509
Mailing Address - Country:US
Mailing Address - Phone:815-519-6388
Mailing Address - Fax:
Practice Address - Street 1:6938 E MONACO PKWY
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-6462
Practice Address - Country:US
Practice Address - Phone:815-519-6388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-08
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13373225X00000X, 225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty