Provider Demographics
NPI:1376109876
Name:YANG, MICHELLE JENNIFER-LEE (MA, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:JENNIFER-LEE
Last Name:YANG
Suffix:
Gender:F
Credentials:MA, OTR/L
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:JENNIFER
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, OTR/L
Mailing Address - Street 1:255 E BONITA AVE
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-1933
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:255 E BONITA AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-1923
Practice Address - Country:US
Practice Address - Phone:909-596-7733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-10
Last Update Date:2021-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16802225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics