Provider Demographics
NPI:1336122134
Name:WONG, LORI LEE (OT)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:LEE
Last Name:WONG
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 SOUTH DR
Mailing Address - Street 2:SUITE 211
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-4213
Mailing Address - Country:US
Mailing Address - Phone:650-934-0455
Mailing Address - Fax:650-934-0456
Practice Address - Street 1:525 SOUTH DR
Practice Address - Street 2:SUITE 211
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4213
Practice Address - Country:US
Practice Address - Phone:650-934-0455
Practice Address - Fax:650-934-0456
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT1609225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ28185ZOtherMEDICARE GROUP PTAN - FOREST
CAZZZ28190ZOtherMEDICARE GROUP PTAN - MT VIEW
CAZZZ28185ZOtherMEDICARE GROUP PTAN - FOREST