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NPI Code Detail

MEDICARE: JILLIAN LEE

MEDICARE: JILLIAN LEE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225700000XMassage Therapist22838OR

General Provider Information

NPI Number : 1376059451
Entity Type Code : Individual
Provider Name (Legal Business Name) : JILLIAN LEE
Provider Business Mailing Address
First Line : PO BOX 7051
Second Line :
City : BEND
State : OR
Zip : 97708-7051
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 222 SE URANIA LN
Second Line :
City : BEND
State : OR
Zip : 97702-1624
Country : US
Telephone Number : 541-410-5135
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/27/2017
Last Update Date : 12/27/2017

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Directions to “ JILLIAN LEE ” Practice Location

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