Active NPI
Leslie Brunner, OT
- Occupational Therapist
- Santa Rosa, CA
National Provider Identifier
1093414591
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 19757
- Practice address
- 401 Bicentennial Way
Santa Rosa, CA 95403-2149 - Phone
- (707) 393-4000
- NPI assigned
- Feb 23, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 19757 | CA | Primary |
Addresses
Primary practice location
401 Bicentennial Way
Santa Rosa, CA 95403-2149
Mailing address
1807 Orchard St
Santa Rosa, CA 95404-2444
Phone (707) 480-4228
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19757 | CA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1677110400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1677110400000",
"number": "1093414591",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1807 ORCHARD ST",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954042444",
"telephone_number": "707-480-4228"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "401 BICENTENNIAL WAY",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954032149",
"telephone_number": "707-393-4000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRUNNER",
"first_name": "LESLIE",
"credential": "OT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-02-23",
"last_updated": "2023-02-23",
"certification_date": "2023-02-23",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "CA",
"license": "19757",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Rosa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.