Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 14821 | CA |
NPI | 1063800423 |
---|---|
Provider Name | Mrs. Josephine Chou Wong |
First Address | Rancho Cucamonga, CA 91701-9221 |
Second Address | La Palma, CA 90623-1796 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2015 |
Last Update Date | 24/05/2017 |