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NPI Code Detail

MEDICARE: MR. MATTHEW LEE BS

MEDICARE:  MR. MATTHEW  LEE  BS
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
1225X00000XOccupational Therapist5806NC

General Provider Information

NPI Number : 1770747412
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MATTHEW LEE BS
Provider Business Mailing Address
First Line : 714 ANTRIM MEADOW LN
Second Line :
City : CARY
State : NC
Zip : 27519-8857
Country : US
Telephone Number : 919-776-9602
Fax Number :
Provider Business Practice Location Address
First Line : 2702 FARRELL RD
Second Line :
City : SANFORD
State : NC
Zip : 27330-6505
Country : US
Telephone Number : 919-776-9602
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2008
Last Update Date : 07/11/2008

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