Provider Demographics
NPI:1154361095
Name:LEE, MARY KAY (OTR/L, MOT)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:KAY
Last Name:LEE
Suffix:
Gender:F
Credentials:OTR/L, MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10813 PINE REACH CT
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-2742
Mailing Address - Country:US
Mailing Address - Phone:804-767-7299
Mailing Address - Fax:
Practice Address - Street 1:10813 PINE REACH CT
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-2742
Practice Address - Country:US
Practice Address - Phone:804-767-7299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2009-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119004580225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist