Provider Demographics
NPI:1376108696
Name:YANG, TOULONG SAILUE (OTR)
Entity Type:Individual
Prefix:
First Name:TOULONG
Middle Name:SAILUE
Last Name:YANG
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8965 REEPSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:VALE
Mailing Address - State:NC
Mailing Address - Zip Code:28168-6761
Mailing Address - Country:US
Mailing Address - Phone:715-383-9651
Mailing Address - Fax:
Practice Address - Street 1:8965 REEPSVILLE RD
Practice Address - Street 2:
Practice Address - City:VALE
Practice Address - State:NC
Practice Address - Zip Code:28168-6761
Practice Address - Country:US
Practice Address - Phone:715-383-9651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12464225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
419678OtherNBCOT
NC12464OtherNORTH CAROLINA BOARDS OF OCCUPATIONAL THERAPY