Provider Demographics
NPI:1639665060
Name:LEE, SUZANNE SUNMEE (OTA/L)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:SUNMEE
Last Name:LEE
Suffix:
Gender:F
Credentials:OTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46-283 KAHUHIPA ST APT C306
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-6068
Mailing Address - Country:US
Mailing Address - Phone:732-500-0730
Mailing Address - Fax:
Practice Address - Street 1:46-283 KAHUHIPA ST APT C306
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-6068
Practice Address - Country:US
Practice Address - Phone:732-500-0730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOTA-14224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant