Provider Demographics
NPI:1376857243
Name:LEE, CHUCK (OTR)
Entity Type:Individual
Prefix:MR
First Name:CHUCK
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 DALNY PL
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-3013
Mailing Address - Country:US
Mailing Address - Phone:516-377-4199
Mailing Address - Fax:516-377-4199
Practice Address - Street 1:3041 AVE U
Practice Address - Street 2:VISITING THERAPY ASSOCIATION
Practice Address - City:BKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229
Practice Address - Country:US
Practice Address - Phone:718-615-0049
Practice Address - Fax:718-615-1972
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-03
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY03302-1171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor