Provider Demographics
NPI:1982118915
Name:JOBE, LESA ANN (COTA)
Entity type:Individual
Prefix:MRS
First Name:LESA
Middle Name:ANN
Last Name:JOBE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19385 HIGHWAY P
Mailing Address - Street 2:
Mailing Address - City:IONIA
Mailing Address - State:MO
Mailing Address - Zip Code:65335-2031
Mailing Address - Country:US
Mailing Address - Phone:660-287-3825
Mailing Address - Fax:
Practice Address - Street 1:54 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-3050
Practice Address - Country:US
Practice Address - Phone:573-378-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-29
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004593224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant