Provider Demographics
NPI:1427528769
Name:LEE, TAMIKA MONIQUE (LMT)
Entity type:Individual
Prefix:
First Name:TAMIKA
Middle Name:MONIQUE
Last Name:LEE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:TAMIKA
Other - Middle Name:MONIQUE
Other - Last Name:LEE-VEERAPEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:68 CRUSADER CT
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:SC
Mailing Address - Zip Code:29045-8144
Mailing Address - Country:US
Mailing Address - Phone:803-421-9795
Mailing Address - Fax:
Practice Address - Street 1:566 SPEARS CREEK CHURCH RD STE 100
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:SC
Practice Address - Zip Code:29045-8128
Practice Address - Country:US
Practice Address - Phone:803-529-1089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-29
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6089225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist