Healthcare Provider Details

I. General information

NPI: 1285034512
Provider Name (Legal Business Name): TED DAVIS LEE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2014
Last Update Date: 10/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 E KATELLA AVE SUITE 405, BUILDING 8
ANAHEIM CA
92806-5945
US

IV. Provider business mailing address

2400 E KATELLA AVE SUITE 405, BUILDING 8
ANAHEIM CA
92806-5945
US

V. Phone/Fax

Practice location:
  • Phone: 714-712-9922
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: