Provider Demographics
NPI:1992119317
Name:LEE, ZHANNA (COTA/L)
Entity type:Individual
Prefix:
First Name:ZHANNA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 SILVER LEAF WAY
Mailing Address - Street 2:APT 13
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-5907
Mailing Address - Country:US
Mailing Address - Phone:401-743-8501
Mailing Address - Fax:
Practice Address - Street 1:74 SILVER LEAF WAY
Practice Address - Street 2:APT 13
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-5907
Practice Address - Country:US
Practice Address - Phone:401-743-8501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3780224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant