Provider Demographics
NPI:1851108054
Name:LEE, JUNG HYUN (OTR/L)
Entity type:Individual
Prefix:
First Name:JUNG
Middle Name:HYUN
Last Name:LEE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1854 AUBRURN ROAD
Mailing Address - Street 2:SUIT 101
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019
Mailing Address - Country:US
Mailing Address - Phone:770-904-6009
Mailing Address - Fax:770-904-2357
Practice Address - Street 1:1854 AUBRURN ROAD
Practice Address - Street 2:SUIT 101
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019
Practice Address - Country:US
Practice Address - Phone:770-904-6009
Practice Address - Fax:770-904-2357
Is Sole Proprietor?:No
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT009381225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist