MEDICARE: DIANE DAYOUNG LEE OTR/L

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
1	225X00000X	Occupational Therapist	OT17384	CA

General Provider Information

NPI Number	:	1457833212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE DAYOUNG LEE OTR/L

Provider Business Mailing Address
First Line	:	15521 ESCALONA RD
Second Line	:
City	:	LA MIRADA
State	:	CA
Zip	:	90638-4643
Country	:	US
Telephone Number	:	714-315-0876
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 E WASHINGTON AVE
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92701-3843
Country	:	US
Telephone Number	:	714-973-1656
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2018
Last Update Date	:	08/29/2018

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