Provider Demographics
NPI:1417445503
Name:WONG, KRISTINE (OTR,)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:OTR,
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:
Other - Last Name:SAIKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:98-1605 PIKI ST
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-1731
Mailing Address - Country:US
Mailing Address - Phone:707-980-0509
Mailing Address - Fax:
Practice Address - Street 1:1034 KILANI AVE STE 109
Practice Address - Street 2:
Practice Address - City:WAHIAWA
Practice Address - State:HI
Practice Address - Zip Code:96786
Practice Address - Country:US
Practice Address - Phone:808-621-2322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-25
Last Update Date:2018-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1765225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty