Provider Demographics
NPI:1164947545
Name:LEE, ANDREA CORINA (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:CORINA
Last Name:LEE
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 GOLDENROD LANE
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582
Mailing Address - Country:US
Mailing Address - Phone:1925-858-9403
Mailing Address - Fax:
Practice Address - Street 1:2210 GOLDENROD LN
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94582-5548
Practice Address - Country:US
Practice Address - Phone:925-858-9403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-07
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17659225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist