Provider Demographics
NPI:1457534398
Name:WONG, LAUREEN S (OTR/L)
Entity Type:Individual
Prefix:
First Name:LAUREEN
Middle Name:S
Last Name: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 1:3403 TECHNOLOGICAL AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-1476
Mailing Address - Country:US
Mailing Address - Phone:407-681-2520
Mailing Address - Fax:407-681-2521
Practice Address - Street 1:3403 TECHNOLOGICAL AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-1476
Practice Address - Country:US
Practice Address - Phone:407-681-2520
Practice Address - Fax:407-681-2521
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT950225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist