Provider Demographics
NPI:1821313255
Name:LEE, PAMELA
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:752 RUNAWAY DR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN RUN
Mailing Address - State:KY
Mailing Address - Zip Code:42133-8539
Mailing Address - Country:US
Mailing Address - Phone:270-590-4466
Mailing Address - Fax:270-434-3540
Practice Address - Street 1:752 RUNAWAY DR
Practice Address - Street 2:
Practice Address - City:FOUNTAIN RUN
Practice Address - State:KY
Practice Address - Zip Code:42133-8539
Practice Address - Country:US
Practice Address - Phone:270-590-4466
Practice Address - Fax:270-434-3540
Is Sole Proprietor?:No
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management