Basic Information
| Provider Information | |||||||||
| NPI: | 1942567771 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOON | ||||||||
| FirstName: | MAN LAI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | O,T, | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KOON | ||||||||
| OtherFirstName: | HELEN | ||||||||
| OtherMiddleName: | MAN LAI | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | O.T. | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 222 39TH AVENUE WEST | ||||||||
| Address2: | 2ND FLOOR, REHABILITAION DEPARTMENT | ||||||||
| City: | SAN MATEO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6505732472 | ||||||||
| FaxNumber: | 6505733491 | ||||||||
| Practice Location | |||||||||
| Address1: | 222 39TH AVENUE WEST | ||||||||
| Address2: | 2ND FLOOR, REHABILITAION DEPARTMENT | ||||||||
| City: | SAN MATEO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6505732472 | ||||||||
| FaxNumber: | 6505733491 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2012 | ||||||||
| LastUpdateDate: | 04/18/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT2049 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.