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General NPI Number Information
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NPI Number | 1932911575
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Entity Type | Individual
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Provider Name | KELSEY WONG
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Gender | Female
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Dates
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Enumeration Date | 01/21/2025
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Last Update Date | 01/21/2025
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Provider Practice Location Address
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Address Line | 1501 SKYLINE DR
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City | MONTEREY
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State | CA
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Zip | 93940-4110
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Country | US
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Telephone | 831-373-3716
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Fax |
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Provider Business Mailing Address
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Address Line | 907 PUKU ST
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City | HILO
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State | HI
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Zip | 96720-6214
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Country | US
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Telephone | 808-987-7264
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTP-OTA-LIC-11520
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License Number State | MT
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