Provider Demographics
NPI:1801013537
Name:HAGIO, ELIZABETH WONG (OTR)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:WONG
Last Name:HAGIO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:WONG
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:4670 BRYSON TER
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-1331
Mailing Address - Country:US
Mailing Address - Phone:858-847-7368
Mailing Address - Fax:
Practice Address - Street 1:4670 BRYSON TER
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-1331
Practice Address - Country:US
Practice Address - Phone:858-847-7368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT2704225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist