Provider Demographics
NPI:1821766098
Name:LEE, FELICIA RYAN
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:RYAN
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 1:1240 S PINE ISLAND RD APT 528
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-4498
Mailing Address - Country:US
Mailing Address - Phone:347-572-1962
Mailing Address - Fax:
Practice Address - Street 1:1240 S PINE ISLAND RD APT 528
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-4498
Practice Address - Country:US
Practice Address - Phone:347-572-1962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL000256977490222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist