Provider Demographics
NPI:1457486672
Name:LEE, TERESA (OTR)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10232 GERONIMO DR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73026-5922
Mailing Address - Country:US
Mailing Address - Phone:405-308-1011
Mailing Address - Fax:405-321-6143
Practice Address - Street 1:800 W ROCK CREEK RD
Practice Address - Street 2:SUITE 103
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-8586
Practice Address - Country:US
Practice Address - Phone:405-321-6114
Practice Address - Fax:405-321-6143
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics