Provider Demographics
NPI:1316486947
Name:LEE, CARLEY BETH (OTR)
Entity type:Individual
Prefix:
First Name:CARLEY
Middle Name:BETH
Last Name:LEE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8791 STONE GATE LN
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-5158
Mailing Address - Country:US
Mailing Address - Phone:812-243-4250
Mailing Address - Fax:
Practice Address - Street 1:1001 SYCAMORE LN
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IN
Practice Address - Zip Code:46122-1474
Practice Address - Country:US
Practice Address - Phone:317-745-4715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31006262A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist