Provider Demographics
NPI:1821486812
Name:LEE, TAMI SUE (CMT, LMT)
Entity Type:Individual
Prefix:MRS
First Name:TAMI
Middle Name:SUE
Last Name:LEE
Suffix:
Gender:F
Credentials:CMT, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2697 W DEERFIELD CT
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-2339
Mailing Address - Country:US
Mailing Address - Phone:208-863-8968
Mailing Address - Fax:
Practice Address - Street 1:841 E FAIRVIEW AVE STE 100
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-9386
Practice Address - Country:US
Practice Address - Phone:208-863-8968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-29
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMASG-153174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist