Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 11551 | NC |
NPI | 1003300591 |
---|---|
Provider Name | Lara Ashley Lee |
First Address | Durham, NC 27713-1802 |
Second Address | Chapel Hill, NC 27514 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2018 |
Last Update Date | 12/01/2021 |