Provider Demographics
NPI:1003300591
Name:LEE, LARA ASHLEY
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:ASHLEY
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3630 S ALSTON AVE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-1802
Mailing Address - Country:US
Mailing Address - Phone:919-210-0632
Mailing Address - Fax:
Practice Address - Street 1:101 MANNING DRIVE
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514
Practice Address - Country:US
Practice Address - Phone:984-974-5300
Practice Address - Fax:984-974-5303
Is Sole Proprietor?:No
Enumeration Date:2018-06-18
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11551225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist