Basic Information
| Provider Information | |||||||||
| NPI: | 1740657972 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NG | ||||||||
| FirstName: | PAULINE | ||||||||
| MiddleName: | W. | ||||||||
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| Credential: | MOT, OTR/L, CHT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 WATERTHRUSH CT | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958312347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164219678 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1201 ALHAMBRA BLVD STE 200 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958165241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167317900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2015 | ||||||||
| LastUpdateDate: | 08/24/2015 | ||||||||
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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 | 963 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225XH1200X | 963 | CA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand |
No ID Information.