MEDICARE: ELIENAE HERNANDEZ WONG OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	26901	FL

General Provider Information

NPI Number	:	1568067411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIENAE HERNANDEZ WONG OTR/L

Provider Business Mailing Address
First Line	:	18459 PINES BLVD # 109
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33029-1400
Country	:	US
Telephone Number	:	786-468-6692
Fax Number	:

Provider Business Practice Location Address
First Line	:	7777 DAVIE ROAD EXT STE 303B
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-2503
Country	:	US
Telephone Number	:	786-468-6692
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2020
Last Update Date	:	02/19/2026

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