Basic Information
| Provider Information | |||||||||
| NPI: | 1457534398 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WONG | ||||||||
| FirstName: | LAUREEN | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3403 TECHNOLOGICAL AVE | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328171476 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4076812520 | ||||||||
| FaxNumber: | 4076812521 | ||||||||
| Practice Location | |||||||||
| Address1: | 3403 TECHNOLOGICAL AVE | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328171476 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4076812520 | ||||||||
| FaxNumber: | 4076812521 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2007 | ||||||||
| LastUpdateDate: | 12/13/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT950 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.