Provider Demographics
NPI:1235326414
Name:LIU, HAE WON (OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:HAE
Middle Name:WON
Last Name:LIU
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:STEPHANIE
Other - Middle Name:JEN
Other - Last Name:LIU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:2727 W OLYMPIC BLVD STE 302
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2699
Mailing Address - Country:US
Mailing Address - Phone:213-382-0088
Mailing Address - Fax:213-380-2038
Practice Address - Street 1:2727 W OLYMPIC BLVD STE 302
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2699
Practice Address - Country:US
Practice Address - Phone:213-382-0088
Practice Address - Fax:213-380-2038
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-01
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8542225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist