Provider Demographics
NPI:1669435061
Name:LEE, DEANDREA VONTRESE (OT)
Entity type:Individual
Prefix:MRS
First Name:DEANDREA
Middle Name:VONTRESE
Last Name:LEE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MS
Other - First Name:DEANDREA
Other - Middle Name:VONTRESE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:1845 ACORN RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-5143
Mailing Address - Country:US
Mailing Address - Phone:850-545-0114
Mailing Address - Fax:
Practice Address - Street 1:1845 ACORN RIDGE TRL
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-5143
Practice Address - Country:US
Practice Address - Phone:850-545-0114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-08
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004295225X00000X
FLOT9334225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist