Provider Demographics
NPI:1275970659
Name:LEE, ORA M
Entity Type:Individual
Prefix:
First Name:ORA
Middle Name:M
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40186
Mailing Address - Street 2:UNIT 4
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81504-0186
Mailing Address - Country:US
Mailing Address - Phone:970-812-4044
Mailing Address - Fax:970-241-0760
Practice Address - Street 1:514 28 1/4 RD
Practice Address - Street 2:UNIT 4
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-4961
Practice Address - Country:US
Practice Address - Phone:970-812-4044
Practice Address - Fax:970-241-0760
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-26
Last Update Date:2013-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO45-2718356174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator