Healthcare Provider Details

I. General information

NPI: 1215569397
Provider Name (Legal Business Name): PATRICIA LEE OCCUPATIONAL THERAPY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRISH LEE OCCUPATIONAL THERAPY

II. Dates (important events)

Enumeration Date: 02/06/2020
Last Update Date: 02/06/2020
Certification Date: 02/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2743 VETERAN AVE
LOS ANGELES CA
90064-4239
US

IV. Provider business mailing address

2743 VETERAN AVE
LOS ANGELES CA
90064-4239
US

V. Phone/Fax

Practice location:
  • Phone: 310-980-4066
  • Fax:
Mailing address:
  • Phone: 310-980-4066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number6961
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number6961
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number6961
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: