Provider Demographics
NPI:1629291778
Name:TOBER, LEE CHARLES (OT)
Entity Type:Individual
Prefix:MR
First Name:LEE
Middle Name:CHARLES
Last Name:TOBER
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 LACEBARK CT
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:MD
Mailing Address - Zip Code:21221-1750
Mailing Address - Country:US
Mailing Address - Phone:410-391-8455
Mailing Address - Fax:
Practice Address - Street 1:14502 GREENVIEW DR STE 406
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-4220
Practice Address - Country:US
Practice Address - Phone:866-566-5310
Practice Address - Fax:866-566-5311
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04964225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist