Provider Demographics
NPI:1861636946
Name:OETTING WONG, SUSAN (OTR/L)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:OETTING WONG
Suffix:
Gender:F
Credentials: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:PO BOX 5803
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-8803
Mailing Address - Country:US
Mailing Address - Phone:808-430-0428
Mailing Address - Fax:
Practice Address - Street 1:944 WEST KAWAILANI STREET
Practice Address - Street 2:LIFE CARE CENTER OF HILO
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-3218
Practice Address - Country:US
Practice Address - Phone:808-959-9151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI878225XP0019X
NY007957-1225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation