Provider Demographics
NPI:1023843588
Name:LEE, CYNTHIA YOUNGSUN (OTR/L)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:YOUNGSUN
Last Name:LEE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8644 ABBEY DELL AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-6546
Mailing Address - Country:US
Mailing Address - Phone:702-335-0022
Mailing Address - Fax:
Practice Address - Street 1:8020 W SAHARA AVE STE 160
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-7917
Practice Address - Country:US
Practice Address - Phone:702-595-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVOT-3530225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist