Jaclyn Renee Lieske, COTA

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

200079 Issued in MN

Practice address

621 S 4TH St
Le Sueur, MN 56058-2203

Phone

(507) 665-8689

NPI assigned

Nov 4, 2024

Last updated

Nov 4, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1730678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730678400000",
    "number": "1811710361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "37759 280TH ST",
            "city": "HENDERSON",
            "state": "MN",
            "postal_code": "560443502",
            "telephone_number": "507-380-6704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 S 4TH ST",
            "city": "LE SUEUR",
            "state": "MN",
            "postal_code": "560582203",
            "telephone_number": "507-665-8689"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIESKE",
        "first_name": "JACLYN",
        "middle_name": "RENEE",
        "credential": "COTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-11-04",
        "last_updated": "2024-11-04",
        "certification_date": "2024-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "MN",
            "license": "200079",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Asma Khalid Butler, MD
• Nicole Koukol
• Le Sueur Assisted Living
• Le Sueur Eyecare Center LLC (Le Sueur Eyecare Center)
• Lesueur Family Dental
• James F Logue, DC
• Midwest Foot and Ankle Specialists, LLC
• Minnesota Valley Health Center Inc
• Minnesota Valley Health Center Inc
• Minnesota Valley Health Center Inc

• Occupational Therapy Assistant in Le Sueur, MN
• Providers in Le Sueur, MN by specialty
• Occupational Therapy Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.