Provider Demographics
NPI:1053445288
Name:HONG, B NOELANI (PHDOTRL)
Entity Type:Individual
Prefix:DR
First Name:B NOELANI
Middle Name:
Last Name:HONG
Suffix:
Gender:F
Credentials:PHDOTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ESS GANADO USD
Mailing Address - Street 2:PO BOX 1757
Mailing Address - City:GANADO
Mailing Address - State:AZ
Mailing Address - Zip Code:86505
Mailing Address - Country:US
Mailing Address - Phone:928-755-1020
Mailing Address - Fax:
Practice Address - Street 1:ESS GANADO USD
Practice Address - Street 2:HIGHWAY 264
Practice Address - City:GANADO
Practice Address - State:AZ
Practice Address - Zip Code:86505
Practice Address - Country:US
Practice Address - Phone:928-755-1020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3141225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist