Provider Demographics
NPI:1578158705
Name:NG, RONALD (OT)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:NG
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6328 FAIRMOUNT AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-3611
Mailing Address - Country:US
Mailing Address - Phone:510-525-2700
Mailing Address - Fax:510-525-2716
Practice Address - Street 1:6328 FAIRMOUNT AVE STE 220
Practice Address - Street 2:
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530-3611
Practice Address - Country:US
Practice Address - Phone:510-525-2700
Practice Address - Fax:510-525-2716
Is Sole Proprietor?:No
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22167225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA22167OtherOT LICENSE