Provider Demographics
NPI:1285162354
Name:LEE, ALI
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1249 S ANSON RD
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:KS
Mailing Address - Zip Code:67022-8337
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1249 S ANSON RD
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:KS
Practice Address - Zip Code:67022-8337
Practice Address - Country:US
Practice Address - Phone:620-845-4436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-01
Last Update Date:2017-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer