Provider Demographics
NPI:1285411793
Name:LEE, JAYDEN MACKENZIE (OTD)
Entity type:Individual
Prefix:MISS
First Name:JAYDEN
Middle Name:MACKENZIE
Last Name:LEE
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 FARM AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:OH
Mailing Address - Zip Code:45005-2721
Mailing Address - Country:US
Mailing Address - Phone:937-743-8640
Mailing Address - Fax:937-743-8642
Practice Address - Street 1:16 FARM AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:OH
Practice Address - Zip Code:45005-2721
Practice Address - Country:US
Practice Address - Phone:937-743-8640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH493092225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist