Provider Demographics
NPI:1356708226
Name:LEE, SAMANTHA LEA (MOT)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:LEA
Last Name:LEE
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:MISS
Other - First Name:SAMANTHA
Other - Middle Name:LEA
Other - Last Name:STONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT
Mailing Address - Street 1:2735 SEMINARY CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-2896
Mailing Address - Country:US
Mailing Address - Phone:314-610-4118
Mailing Address - Fax:
Practice Address - Street 1:2735 SEMINARY CT
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-2896
Practice Address - Country:US
Practice Address - Phone:314-610-4118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-24
Last Update Date:2016-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYBOTOCT00221966225X00000X
MO2015026973225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist