Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 9549 | CA |
NPI | 1396066726 |
---|---|
Provider Name | May Wong |
First Address | Mountain View, CA 94041-1353 |
Second Address | Mountain View, CA 94041-1353 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2010 |
Last Update Date | 21/06/2010 |