Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | ||
N | 225XH1200X | Occupational Therapist - Hand |
NPI | 1285034512 |
---|---|
Provider Name | Ted Davis Lee |
First Address | Anaheim, CA 92806-5945 |
Second Address | Anaheim, CA 92806-5945 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2014 |
Last Update Date | 02/10/2016 |