Healthcare Provider Details

I. General information

NPI: 1629770417
Provider Name (Legal Business Name): CHRISTINA G LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2023
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 OLD MEADOW RD STE 205
MC LEAN VA
22102-4330
US

IV. Provider business mailing address

PO BOX 715868
PHILADELPHIA PA
19171-5868
US

V. Phone/Fax

Practice location:
  • Phone: 703-810-5214
  • Fax: 703-810-5475
Mailing address:
  • Phone: 804-915-1910
  • Fax: 804-968-1803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number15808
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number0119011205
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: