Provider Demographics
NPI:1457833212
Name:LEE, DIANE DAYOUNG (OTR/L)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:DAYOUNG
Last Name:LEE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:DAYOUNG
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:15521 ESCALONA RD
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-4643
Mailing Address - Country:US
Mailing Address - Phone:714-315-0876
Mailing Address - Fax:
Practice Address - Street 1:600 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-3843
Practice Address - Country:US
Practice Address - Phone:714-973-1656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT17384225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist