Provider Demographics
NPI:1033268115
Name:LEE, WANDA MARIE (OTR)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:MARIE
Last Name:LEE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:WANDA
Other - Middle Name:MARIE
Other - Last Name:GEYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:1047 N HUNT CLUB DR
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:FL
Mailing Address - Zip Code:34442-6372
Mailing Address - Country:US
Mailing Address - Phone:352-344-9755
Mailing Address - Fax:352-344-9411
Practice Address - Street 1:1047 N HUNT CLUB DR
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:FL
Practice Address - Zip Code:34442-6372
Practice Address - Country:US
Practice Address - Phone:352-344-9755
Practice Address - Fax:352-344-9411
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12719225X00000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist