Provider Demographics
NPI:1083295349
Name:WONG, ANDREW M (MS, OTR/L)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:M
Last Name:WONG
Suffix:
Gender:M
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CHRYSLER RD APT 1013
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-1683
Mailing Address - Country:US
Mailing Address - Phone:808-264-6389
Mailing Address - Fax:
Practice Address - Street 1:5 CHRYSLER RD APT 1013
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-1683
Practice Address - Country:US
Practice Address - Phone:808-264-6389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022999225X00000X
MA13726225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist