Provider Demographics
NPI:1154649747
Name:LEE, CARLY (ATC)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9793 NEISWANDER RD
Mailing Address - Street 2:
Mailing Address - City:ASHVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43103-9741
Mailing Address - Country:US
Mailing Address - Phone:614-837-7882
Mailing Address - Fax:
Practice Address - Street 1:9793 NEISWANDER RD
Practice Address - Street 2:
Practice Address - City:ASHVILLE
Practice Address - State:OH
Practice Address - Zip Code:43103-9741
Practice Address - Country:US
Practice Address - Phone:614-837-7882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-07
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT.0031972255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer