Provider Demographics
NPI:1790192649
Name:LEYONE, JANELLE RENEE (OT)
Entity type:Individual
Prefix:
First Name:JANELLE
Middle Name:RENEE
Last Name:LEYONE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3750 S 209TH PL APT C306
Mailing Address - Street 2:
Mailing Address - City:SEATAC
Mailing Address - State:WA
Mailing Address - Zip Code:98198-4339
Mailing Address - Country:US
Mailing Address - Phone:619-218-2978
Mailing Address - Fax:
Practice Address - Street 1:1291 CRAIG AVE
Practice Address - Street 2:
Practice Address - City:LAKEPORT
Practice Address - State:CA
Practice Address - Zip Code:95453-5704
Practice Address - Country:US
Practice Address - Phone:707-263-6382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-11
Last Update Date:2018-10-09
Deactivation Date:2015-02-10
Deactivation Code:
Reactivation Date:2018-10-09
Provider Licenses
StateLicense IDTaxonomies
CA1424224Z00000X
VA0119-007554225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant