Individual
RYAN LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OT
Contact information
Practice address
3218 DAUGHERTY DR STE 160, LAFAYETTE, IN 47909-4402
(765) 477-6464
(765) 477-6262
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
(630) 296-2223
(630) 759-9510
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
31003989A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000319250
ANTHEM PROVIDER NUMBER
IN
05
—
200476540
—
IN
Enumeration date
03/23/2006
Last updated
10/28/2016
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