MEDICARE: ELIZABETH WONG HAGIO OTR

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	OT2704	CA

General Provider Information

NPI Number	:	1801013537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH WONG HAGIO OTR

Provider Business Mailing Address
First Line	:	4670 BRYSON TER
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-1331
Country	:	US
Telephone Number	:	858-847-7368
Fax Number	:

Provider Business Practice Location Address
First Line	:	4670 BRYSON TER
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-1331
Country	:	US
Telephone Number	:	858-847-7368
Fax Number	:

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

Provider Enumeration Date	:	04/20/2007
Last Update Date	:	07/08/2007

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