Provider Demographics
NPI:1366207623
Name:WONG, SYLVIA (OTR/L)
Entity type:Individual
Prefix:
First Name:SYLVIA
Middle Name:
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 1:1725 NEIL ARMSTRONG ST UNIT 106
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-1933
Mailing Address - Country:US
Mailing Address - Phone:626-231-6640
Mailing Address - Fax:
Practice Address - Street 1:1725 NEIL ARMSTRONG ST UNIT 106
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-1933
Practice Address - Country:US
Practice Address - Phone:626-231-6640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT21450225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist