Provider Demographics
NPI:1487950150
Name:LEE, YU-JUNG (OT)
Entity type:Individual
Prefix:
First Name:YU-JUNG
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:RONNIE
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OT
Mailing Address - Street 1:2621 RIDGEPOINT DR
Mailing Address - Street 2:STE 130
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78754-5232
Mailing Address - Country:US
Mailing Address - Phone:512-583-9679
Mailing Address - Fax:512-334-2321
Practice Address - Street 1:2621 RIDGEPOINT DR
Practice Address - Street 2:140
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78754-5232
Practice Address - Country:US
Practice Address - Phone:512-583-9679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-28
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113939225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist