Provider Demographics
NPI:1194039727
Name:WANG, XIAO BO (OTR/L)
Entity Type:Individual
Prefix:
First Name:XIAO BO
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:SABRINA
Other - Middle Name:
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:163 PALENCIA VILLAGE DR STE 110
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32095-8458
Mailing Address - Country:US
Mailing Address - Phone:904-829-6000
Mailing Address - Fax:904-829-6021
Practice Address - Street 1:163 PALENCIA VILLAGE DR STE 110
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32095-8458
Practice Address - Country:US
Practice Address - Phone:904-829-6000
Practice Address - Fax:904-829-6021
Is Sole Proprietor?:No
Enumeration Date:2010-08-06
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 13693225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist