MEDICARE: MRS. ALLISON HALEY LEE OTR/L

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	OT005381	GA

General Provider Information

NPI Number	:	1609143981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALLISON HALEY LEE OTR/L

Provider Business Mailing Address
First Line	:	5050 RESEARCH CT
Second Line	:	SUITE 800
City	:	SUWANEE
State	:	GA
Zip	:	30024-6606
Country	:	US
Telephone Number	:	770-205-5551
Fax Number	:	678-749-7611

Provider Business Practice Location Address
First Line	:	5050 RESEARCH CT
Second Line	:	SUITE 800
City	:	SUWANEE
State	:	GA
Zip	:	30024-6606
Country	:	US
Telephone Number	:	770-205-5551
Fax Number	:	678-749-7611

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

Provider Enumeration Date	:	11/30/2011
Last Update Date	:	11/30/2011

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