Provider Demographics
NPI:1942567771
Name:KOON, MAN LAI (O,T,)
Entity Type:Individual
Prefix:MS
First Name:MAN LAI
Middle Name:
Last Name:KOON
Suffix:
Gender:F
Credentials:O,T,
Other - Prefix:MS
Other - First Name:HELEN
Other - Middle Name:MAN LAI
Other - Last Name:KOON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OT
Mailing Address - Street 1:222 39TH AVENUE WEST
Mailing Address - Street 2:2ND FLOOR, REHABILITAION DEPARTMENT
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403
Mailing Address - Country:US
Mailing Address - Phone:650-573-2472
Mailing Address - Fax:650-573-3491
Practice Address - Street 1:222 39TH AVENUE WEST
Practice Address - Street 2:2ND FLOOR, REHABILITAION DEPARTMENT
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403
Practice Address - Country:US
Practice Address - Phone:650-573-2472
Practice Address - Fax:650-573-3491
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT2049225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist