MEDICARE: MR. JEFFREY CARL 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	3206	NC

General Provider Information

NPI Number	:	1821268178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFREY CARL LEE OT

Provider Business Mailing Address
First Line	:	3714 SOCO RD
Second Line	:
City	:	MAGGIE VALLEY
State	:	NC
Zip	:	28751-6100
Country	:	US
Telephone Number	:	828-926-2696
Fax Number	:

Provider Business Practice Location Address
First Line	:	3714 SOCO RD
Second Line	:
City	:	MAGGIE VALLEY
State	:	NC
Zip	:	28751-6100
Country	:	US
Telephone Number	:	828-926-2696
Fax Number	:

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

Provider Enumeration Date	:	03/03/2008
Last Update Date	:	03/03/2008

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