Provider Demographics
NPI:1912437450
Name:PUTNAM, ORA LEE (LPTA)
Entity Type:Individual
Prefix:MRS
First Name:ORA
Middle Name:LEE
Last Name:PUTNAM
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3316 WHITTIER AVE
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48506-4717
Mailing Address - Country:US
Mailing Address - Phone:810-287-4055
Mailing Address - Fax:
Practice Address - Street 1:3316 WHITTIER AVE
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48506-4717
Practice Address - Country:US
Practice Address - Phone:810-287-4055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-18
Last Update Date:2017-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502001419225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant