Healthcare Provider Details

I. General information

NPI: 1275015638
Provider Name (Legal Business Name): QUENNA G LEE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2018
Last Update Date: 09/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1948 CALIFORNIA STREET
SAN FRANCISCO CA
94109
US

IV. Provider business mailing address

63 SYLVAN DRIVE
SAN FRANCISCO CA
94132
US

V. Phone/Fax

Practice location:
  • Phone: 703-801-5672
  • Fax:
Mailing address:
  • Phone: 415-664-5247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT19102
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: