MEDICARE: YU-JUNG LEE OT

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	113939	TX

General Provider Information

NPI Number	:	1487950150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YU-JUNG LEE OT

Provider Business Mailing Address
First Line	:	2621 RIDGEPOINT DR
Second Line	:	STE 130
City	:	AUSTIN
State	:	TX
Zip	:	78754-5232
Country	:	US
Telephone Number	:	512-583-9679
Fax Number	:	512-334-2321

Provider Business Practice Location Address
First Line	:	2621 RIDGEPOINT DR
Second Line	:	140
City	:	AUSTIN
State	:	TX
Zip	:	78754-5232
Country	:	US
Telephone Number	:	512-583-9679
Fax Number	:

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

Provider Enumeration Date	:	01/28/2011
Last Update Date	:	01/28/2011

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