Provider Demographics
NPI:1801482377
Name:WONG, ANITA MARIE (OTR/L)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:MARIE
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 1:23 HAMILTON PL
Mailing Address - Street 2:
Mailing Address - City:LAKE GROVE
Mailing Address - State:NY
Mailing Address - Zip Code:11755-1916
Mailing Address - Country:US
Mailing Address - Phone:631-935-2729
Mailing Address - Fax:
Practice Address - Street 1:23 HAMILTON PL
Practice Address - Street 2:
Practice Address - City:LAKE GROVE
Practice Address - State:NY
Practice Address - Zip Code:11755-1916
Practice Address - Country:US
Practice Address - Phone:631-935-2729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-17
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0003278225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontologyGroup - Single Specialty