Provider Demographics
NPI:1902220890
Name:LEE, ADIN
Entity Type:Individual
Prefix:
First Name:ADIN
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 1:575 N SEVEN PEAKS BLVD
Mailing Address - Street 2:#28
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84606-6647
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:575 N SEVEN PEAKS BLVD
Practice Address - Street 2:#28
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84606-6647
Practice Address - Country:US
Practice Address - Phone:620-496-6666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-12
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist