Provider Demographics
NPI:1336198738
Name:MENDOZA, JAMIE M (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:M
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:M
Other - Last Name:LEESER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1120 TREK TRAIL HTS APT 208
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-4515
Mailing Address - Country:US
Mailing Address - Phone:858-922-5402
Mailing Address - Fax:
Practice Address - Street 1:4110 BRIARGATE PKWY STE 300
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7837
Practice Address - Country:US
Practice Address - Phone:719-632-7669
Practice Address - Fax:719-632-0088
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT5817225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWOT5817AMedicare PIN
CAWOT5817DMedicare PIN
CAWOT5817BMedicare PIN
CAWOT5817EMedicare PIN
CAWOT5817CMedicare PIN