Provider Demographics
NPI:1942599402
Name:LEE, ROSE E (MSOT, MPH)
Entity Type:Individual
Prefix:MS
First Name:ROSE
Middle Name:E
Last Name:LEE
Suffix:
Gender:F
Credentials:MSOT, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4324 220TH PL
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-3645
Mailing Address - Country:US
Mailing Address - Phone:917-523-0925
Mailing Address - Fax:718-224-8085
Practice Address - Street 1:4324 220TH PL
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-3645
Practice Address - Country:US
Practice Address - Phone:917-523-0925
Practice Address - Fax:718-224-8085
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015332225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist