Provider Demographics
NPI:1558550814
Name:LEE-PRIDE, JERI ANNETTE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:JERI
Middle Name:ANNETTE
Last Name:LEE-PRIDE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:JERI
Other - Middle Name:ANNETTE
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:92 JUSTINS WAY
Mailing Address - Street 2:
Mailing Address - City:FALLING WATERS
Mailing Address - State:WV
Mailing Address - Zip Code:25419-7072
Mailing Address - Country:US
Mailing Address - Phone:304-274-0460
Mailing Address - Fax:
Practice Address - Street 1:154 N ARTIZAN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:MD
Practice Address - Zip Code:21795-1104
Practice Address - Country:US
Practice Address - Phone:301-223-7971
Practice Address - Fax:301-223-7635
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02563225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist