Provider Demographics
NPI:1801212352
Name:BW OCCUPATIONAL THERAPY PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:BW OCCUPATIONAL THERAPY PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CONG-BANG
Authorized Official - Middle Name:BILL
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:OTD, OTR/L
Authorized Official - Phone:626-307-5830
Mailing Address - Street 1:446 E NEWMARK AVE
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91755-3102
Mailing Address - Country:US
Mailing Address - Phone:626-307-5830
Mailing Address - Fax:626-307-5830
Practice Address - Street 1:446 E NEWMARK AVE
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91755-3102
Practice Address - Country:US
Practice Address - Phone:626-307-5830
Practice Address - Fax:626-307-5830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-07
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13102225XM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental HealthGroup - Single Specialty