Provider Demographics
NPI:1417222654
Name:LEE, KATY (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:KATY
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:692 KIRKWOOD AVE SE UNIT C3
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30316-1137
Mailing Address - Country:US
Mailing Address - Phone:251-232-6418
Mailing Address - Fax:
Practice Address - Street 1:692 KIRKWOOD AVE SE UNIT C3
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30316-1137
Practice Address - Country:US
Practice Address - Phone:251-232-6418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-21
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT005429225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist