Provider Demographics
NPI:1629594122
Name:LEE, TONYA NICHOLE (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:TONYA
Middle Name:NICHOLE
Last Name:LEE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MS
Other - First Name:TONYA
Other - Middle Name:NICHOLE
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTA/L
Mailing Address - Street 1:8607 MENAUL BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-2223
Mailing Address - Country:US
Mailing Address - Phone:505-814-4625
Mailing Address - Fax:
Practice Address - Street 1:8607 MENAUL BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-2223
Practice Address - Country:US
Practice Address - Phone:505-814-4625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3720225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist