Provider Demographics
NPI:1285034512
Name:LEE, TED DAVIS
Entity Type:Individual
Prefix:
First Name:TED
Middle Name:DAVIS
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 1:2400 E KATELLA AVE
Mailing Address - Street 2:SUITE 405, BUILDING 8
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-5945
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2400 E KATELLA AVE
Practice Address - Street 2:SUITE 405, BUILDING 8
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-5945
Practice Address - Country:US
Practice Address - Phone:714-712-9922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-22
Last Update Date:2016-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand