Basic Information
| Provider Information | |||||||||
| NPI: | 1659016251 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEASURE | ||||||||
| FirstName: | ARIEL | ||||||||
| MiddleName: | DIANE | ||||||||
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| Credential: | OTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2081 WHITMAN WAY APT 424 | ||||||||
| Address2: | |||||||||
| City: | SAN BRUNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940664087 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144906280 | ||||||||
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| Practice Location | |||||||||
| Address1: | 33 MATEO AVE | ||||||||
| Address2: | |||||||||
| City: | MILLBRAE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940302037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6506895784 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2022 | ||||||||
| LastUpdateDate: | 05/10/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | CA | N | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225X00000X | 23670 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.