Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | OT60329463 | WA |
NPI | 1053755033 |
---|---|
Provider Name | Stephanie Lee |
First Address | Issaquah, WA 98027-8116 |
Second Address | Issaquah, WA 98027-8116 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2013 |
Last Update Date | 22/04/2013 |