Provider Demographics
NPI:1205188067
Name:CHIANG, FERNANDO (OTR/L)
Entity Type:Individual
Prefix:
First Name:FERNANDO
Middle Name:
Last Name:CHIANG
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 CANAL ST
Mailing Address - Street 2:
Mailing Address - City:KING CITY
Mailing Address - State:CA
Mailing Address - Zip Code:93930-3431
Mailing Address - Country:US
Mailing Address - Phone:831-385-6835
Mailing Address - Fax:831-385-6686
Practice Address - Street 1:300 CANAL ST
Practice Address - Street 2:SUITE C
Practice Address - City:KING CITY
Practice Address - State:CA
Practice Address - Zip Code:93930-3431
Practice Address - Country:US
Practice Address - Phone:831-385-6835
Practice Address - Fax:831-385-6686
Is Sole Proprietor?:No
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12934225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist