Provider Demographics
NPI:1790553527
Name:FONG, HANNA (OTA)
Entity Type:Individual
Prefix:
First Name:HANNA
Middle Name:
Last Name:FONG
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11990 N BAYPOINT CIR
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-4847
Mailing Address - Country:US
Mailing Address - Phone:954-558-1917
Mailing Address - Fax:954-533-4841
Practice Address - Street 1:5500 NW 69TH AVE APT 115
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33319-7267
Practice Address - Country:US
Practice Address - Phone:954-440-2696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA10736224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant