Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 014196-1 | NY |
N | 225XG0600X | Occupational Therapist - Gerontology | ||
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 014196-1 | NY |
N | 225XP0200X | Occupational Therapist - Pediatrics |
NPI | 1063778538 |
---|---|
Provider Name | Miss Pee Pong Lee |
First Address | Brooklyn, NY 11212 |
Second Address | Brooklyn, NY 11212 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2012 |
Last Update Date | 09/04/2012 |