Healthcare Provider Details

I. General information

NPI: 1669085551
Provider Name (Legal Business Name): NAOMI WONG OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 08/28/2020
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 21ST AVE
SAN FRANCISCO CA
94121-2114
US

IV. Provider business mailing address

280 21ST AVE
SAN FRANCISCO CA
94121-2114
US

V. Phone/Fax

Practice location:
  • Phone: 415-706-8912
  • Fax:
Mailing address:
  • Phone: 415-706-8912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number20828
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: