Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT2391 | CA |
NPI | 1245629690 |
---|---|
Provider Name | Maria Therese Lee |
First Address | Fairfax, CA 94930-2202 |
Second Address | Fairfax, CA 94930-2202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2015 |
Last Update Date | 22/01/2015 |