Healthcare Provider Details

I. General information

NPI: 1144977166
Provider Name (Legal Business Name): KRISTIN D. LEE OTR/L, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2022
Last Update Date: 03/17/2022
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 GOODLETTE RD
NAPLES FL
34102-5614
US

IV. Provider business mailing address

670 GOODLETTE RD
NAPLES FL
34102-5614
US

V. Phone/Fax

Practice location:
  • Phone: 239-434-9512
  • Fax:
Mailing address:
  • Phone: 239-434-9512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: KRISTIN D. LEE
Title or Position: OWNER
Credential:
Phone: 239-450-5354