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General NPI Number Information
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NPI Number | 1255591459
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Entity Type | Individual
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Provider Name | JOHNY JOHN R LEE OT
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Gender | Male
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Dates
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Enumeration Date | 06/11/2008
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Last Update Date | 06/11/2008
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Provider Practice Location Address
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Address Line | 1586 W SAN MARCOS BLVD
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City | SAN MARCOS
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State | CA
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Zip | 92078-4019
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Country | US
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Telephone | 760-891-7007
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Fax | 760-471-7731
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Provider Business Mailing Address
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Address Line | 5022 CALLE ARQUERO
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City | OCEANSIDE
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State | CA
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Zip | 92057-2732
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 3720
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License Number State | CA
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