Provider Demographics
NPI:1366636474
Name:LEE, TAMMY (OT)
Entity Type:Individual
Prefix:MISS
First Name:TAMMY
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:
Other - Last Name:RAUG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:265 CHERRY ST
Mailing Address - Street 2:APT 25E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-7932
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1400 PELHAM PKWY S
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1138
Practice Address - Country:US
Practice Address - Phone:718-918-3060
Practice Address - Fax:718-918-4469
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP58603225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist