Provider Demographics
NPI:1609089671
Name:WONG, ANNA MEI TING (OTR)
Entity Type:Individual
Prefix:MS
First Name:ANNA
Middle Name:MEI TING
Last Name:WONG
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2504 HARGRAVE DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90068-2218
Mailing Address - Country:US
Mailing Address - Phone:323-462-5809
Mailing Address - Fax:
Practice Address - Street 1:2504 HARGRAVE DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90068-2218
Practice Address - Country:US
Practice Address - Phone:323-462-5809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT933A225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP88587Medicare UPIN