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General NPI Number Information
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NPI Number | 1649026071
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Entity Type | Individual
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Provider Name | CHRISTEN LEE
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Gender | Female
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Dates
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Enumeration Date | 04/26/2024
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Last Update Date | 04/26/2024
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Provider Practice Location Address
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Address Line | 105 N 5TH AVE
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City | MADILL
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State | OK
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Zip | 73446-1200
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Country | US
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Telephone | 580-872-4277
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Fax | 580-872-4261
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Provider Business Mailing Address
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Address Line | 1405 4TH AVE NW # 296
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City | ARDMORE
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State | OK
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Zip | 73401-2708
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Country | US
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Telephone | 580-226-5566
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 2609
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License Number State | OK
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