Provider Demographics
NPI:1275915787
Name:LEE, LOIS JEAN (LMT OR#8031)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:JEAN
Last Name:LEE
Suffix:
Gender:F
Credentials:LMT OR#8031
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 SW MULTNOMAH BLVD
Mailing Address - Street 2:308
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-4025
Mailing Address - Country:US
Mailing Address - Phone:503-936-4171
Mailing Address - Fax:
Practice Address - Street 1:2929 SW MULTNOMAH BLVD
Practice Address - Street 2:308
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-4025
Practice Address - Country:US
Practice Address - Phone:503-936-4171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-19
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR8031225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist