Provider Demographics
NPI:1750708707
Name:LEE, SERENA (LMP, BS)
Entity type:Individual
Prefix:
First Name:SERENA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:LMP, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52435 SE 496TH PL
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-8073
Mailing Address - Country:US
Mailing Address - Phone:253-223-1067
Mailing Address - Fax:
Practice Address - Street 1:52435 SE 496TH PL
Practice Address - Street 2:
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-8073
Practice Address - Country:US
Practice Address - Phone:253-223-1067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-26
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60058363225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist