MEDICARE: AMY YANNSHIN LEE M.A., OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OT7348	CA

General Provider Information

NPI Number	:	1033286620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY YANNSHIN LEE M.A., OTR

Provider Business Mailing Address
First Line	:	23 FILLMORE
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92620-3293
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	23361 MADERO
Second Line	:	SUITE 150
City	:	MISSION VIEJO
State	:	CA
Zip	:	92691-2715
Country	:	US
Telephone Number	:	949-599-0218
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	07/08/2007

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