Provider Demographics
NPI:1720227317
Name:PON, JENNIFER SUI-WAH (MA, OTR/L)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SUI-WAH
Last Name:PON
Suffix:
Gender:F
Credentials:MA, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16631 NOYES AVE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-5138
Mailing Address - Country:US
Mailing Address - Phone:949-252-9946
Mailing Address - Fax:949-559-4366
Practice Address - Street 1:16631 NOYES AVE
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-5138
Practice Address - Country:US
Practice Address - Phone:949-252-9946
Practice Address - Fax:949-559-4366
Is Sole Proprietor?:No
Enumeration Date:2009-02-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT10413225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics