Basic Information
| Provider Information | |||||||||
| NPI: | 1508087370 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FONG | ||||||||
| FirstName: | ANDREA | ||||||||
| MiddleName: | LAI SIN | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | M.A. OTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3357 ALA ILIMA ST | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968182330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8088331440 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 94-144 FARRINGTON HWY #115 | ||||||||
| Address2: | |||||||||
| City: | WAIPAHU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96767 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8086783814 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 651 | HI | X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225XE1200X | 651 | HI | X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Ergonomics | 225XH1300X | 651 | HI | X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Human Factors | 225XN1300X | 651 | HI | X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Neurorehabilitation | 225XP0200X | 651 | HI | X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics | 225XR0403X | 651 | HI | X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Driving and Community Mobility |
No ID Information.