Provider Demographics
NPI:1477148187
Name:ONG, COURTNEY ELLEN (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ELLEN
Last Name:ONG
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5791 SHASTA CIR
Mailing Address - Street 2:
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623-1841
Mailing Address - Country:US
Mailing Address - Phone:714-723-2503
Mailing Address - Fax:
Practice Address - Street 1:15454 GALE AVE
Practice Address - Street 2:
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-1500
Practice Address - Country:US
Practice Address - Phone:626-330-1538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-04
Last Update Date:2021-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22087225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics