Provider Demographics
NPI:1881663540
Name:LEE, SHERYL ANN (OT)
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:ANN
Last Name:LEE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:SHERYL
Other - Middle Name:ANN
Other - Last Name:POBLETE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:4482 BARRANCA PKWY
Mailing Address - Street 2:STE 195
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-7701
Mailing Address - Country:US
Mailing Address - Phone:949-679-3337
Mailing Address - Fax:949-679-3336
Practice Address - Street 1:4482 BARRANCA PKWY
Practice Address - Street 2:STE 195
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-7701
Practice Address - Country:US
Practice Address - Phone:949-679-3337
Practice Address - Fax:949-679-3336
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT1503225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAZ229XOtherMEDICARE PTAN
Q44795Medicare UPIN
CAAZ229XOtherMEDICARE PTAN