Provider Demographics
NPI:1124269667
Name:VAN VLEIT, LANI ESPE (OTR/L)
Entity type:Individual
Prefix:
First Name:LANI
Middle Name:ESPE
Last Name:VAN VLEIT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:GUADALEA
Other - Middle Name:LANI
Other - Last Name:ESPE VAN VLEIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:914 CHELTENHAM RD
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-2234
Mailing Address - Country:US
Mailing Address - Phone:310-714-3795
Mailing Address - Fax:
Practice Address - Street 1:280 W MACARTHUR BLVD
Practice Address - Street 2:BROADWAY MOB 2ND FLOOR, SUITE 201
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-5642
Practice Address - Country:US
Practice Address - Phone:310-714-3795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2781225XP0200X
CA1028133225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics