Provider Demographics
NPI:1174067581
Name:LEE, VERONICA SANGYEON (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:SANGYEON
Last Name:LEE
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6044 SULTANA AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPLE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91780-1549
Mailing Address - Country:US
Mailing Address - Phone:201-575-2637
Mailing Address - Fax:
Practice Address - Street 1:15454 GALE AVE
Practice Address - Street 2:SUITE E-1
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-1500
Practice Address - Country:US
Practice Address - Phone:626-330-1538
Practice Address - Fax:909-606-9182
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-05
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT16702225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics