Healthcare Provider Details

I. General information

NPI: 1982186516
Provider Name (Legal Business Name): LEE ANN HODGE OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2018
Last Update Date: 08/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 IRIS DR
SALINAS CA
93906-3514
US

IV. Provider business mailing address

200 BUTTON ST APT 111F
SANTA CRUZ CA
95060-2263
US

V. Phone/Fax

Practice location:
  • Phone: 831-449-1515
  • Fax:
Mailing address:
  • Phone: 614-914-7822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number18466
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: