Individual
CARISSA LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6177 RIVER CREST DR, A, RIVERSIDE, CA 92507-0728
(951) 653-4480
(951) 653-5051
Mailing address
6177 RIVER CREST DR, A, RIVERSIDE, CA 92507-0728
(951) 653-4480
(951) 653-5051
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
16353
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16353
LICENSE
CA
Enumeration date
10/17/2016
Last updated
10/17/2016
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