Provider Demographics
NPI:1477207298
Name:KONG, CHELSEA ALAINE (COTA/L)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:ALAINE
Last Name:KONG
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 SANDSTONE ST
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33809-0875
Mailing Address - Country:US
Mailing Address - Phone:786-290-4166
Mailing Address - Fax:
Practice Address - Street 1:606 SHERBURN CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-9017
Practice Address - Country:US
Practice Address - Phone:407-810-2773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18656225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist