MEDICARE: MRS. HEATHER DAWN LEE L.M.T.

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	174400000X	Specialist	27022328	NY
2	225700000X	Massage Therapist	022328	NY

General Provider Information

NPI Number	:	1609103118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HEATHER DAWN LEE L.M.T.

Provider Business Mailing Address
First Line	:	6 MAPLEWOOD AVE
Second Line	:
City	:	FARMINGDALE
State	:	NY
Zip	:	11735-2420
Country	:	US
Telephone Number	:	917-771-4167
Fax Number	:

Provider Business Practice Location Address
First Line	:	6 MAPLEWOOD AVE
Second Line	:
City	:	FARMINGDALE
State	:	NY
Zip	:	11735-2420
Country	:	US
Telephone Number	:	917-771-4167
Fax Number	:

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

Provider Enumeration Date	:	11/05/2009
Last Update Date	:	01/20/2022

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