Healthcare Provider Details

I. General information

NPI: 1376343426
Provider Name (Legal Business Name): TINA LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 OLD LANCASTER RD STE 12
BERWYN PA
19312-1671
US

IV. Provider business mailing address

243 LONG LN
UPPER DARBY PA
19082-4020
US

V. Phone/Fax

Practice location:
  • Phone: 610-225-2451
  • Fax: 610-964-6166
Mailing address:
  • Phone: 610-225-2451
  • Fax: 610-964-6166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC020551
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: