Provider Demographics
NPI:1124265723
Name:LEE, CHRISTINE S
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:S
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:S
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR
Mailing Address - Street 1:7609 BAKER RD
Mailing Address - Street 2:
Mailing Address - City:LOWVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13367-2509
Mailing Address - Country:US
Mailing Address - Phone:315-376-3728
Mailing Address - Fax:
Practice Address - Street 1:7609 BAKER RD
Practice Address - Street 2:
Practice Address - City:LOWVILLE
Practice Address - State:NY
Practice Address - Zip Code:13367-2509
Practice Address - Country:US
Practice Address - Phone:315-376-3728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-19
Last Update Date:2009-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004293-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist