Provider Demographics
NPI:1063463206
Name:MATEFFY, LEE ANN MAE (OTR L)
Entity type:Individual
Prefix:
First Name:LEE ANN
Middle Name:MAE
Last Name:MATEFFY
Suffix:
Gender:F
Credentials:OTR L
Other - Prefix:
Other - First Name:LEE ANN
Other - Middle Name:MAE
Other - Last Name:MATEFFY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3915 GOLDEN VALLEY ROAD
Mailing Address - Street 2:COURAGE CENTER
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-4298
Mailing Address - Country:US
Mailing Address - Phone:763-520-0431
Mailing Address - Fax:763-520-0355
Practice Address - Street 1:3915 GOLDEN VALLEY ROAD
Practice Address - Street 2:COURAGE CENTER
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-4298
Practice Address - Country:US
Practice Address - Phone:763-520-0431
Practice Address - Fax:763-520-0355
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN100553225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
6404024OtherMEDICA
HP41229OtherHEALTH PARTNERS
048G1HOOtherBCBS MINNESOTA