Provider Demographics
NPI:1639325301
Name:AFONG, LAWNA ANN (OT)
Entity Type:Individual
Prefix:MRS
First Name:LAWNA
Middle Name:ANN
Last Name:AFONG
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MISS
Other - First Name:LAWNA
Other - Middle Name:ANN
Other - Last Name:SHIVERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:1322 SW SEAHAWK WAY
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-4248
Mailing Address - Country:US
Mailing Address - Phone:772-223-7762
Mailing Address - Fax:
Practice Address - Street 1:1483 SW BOUGAINVILLEA AVE
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-7302
Practice Address - Country:US
Practice Address - Phone:772-336-6928
Practice Address - Fax:772-336-6929
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT9648225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist