Basic Information
| Provider Information | |||||||||
| NPI: | 1982092516 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ONG | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Credential: | COTA/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10438 RUE DU NUAGE | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921312357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8585784989 | ||||||||
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| Practice Location | |||||||||
| Address1: | 15720 BERNARDO CENTER DR | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921275861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8586723900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2015 | ||||||||
| LastUpdateDate: | 01/05/2015 | ||||||||
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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 | 224Z00000X | 2071 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.