Provider Demographics
NPI:1912141599
Name:LEE, PEARL POON (OTR/L)
Entity Type:Individual
Prefix:
First Name:PEARL
Middle Name:POON
Last Name:LEE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:PEARL
Other - Middle Name:
Other - Last Name:POON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:204 ACCOLADE DR
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-1596
Mailing Address - Country:US
Mailing Address - Phone:510-383-1122
Mailing Address - Fax:
Practice Address - Street 1:204 ACCOLADE DR
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-1596
Practice Address - Country:US
Practice Address - Phone:510-383-1122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2801225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist