Provider Demographics
NPI:1487289898
Name:WANG, SUYEON JEON (OT)
Entity type:Individual
Prefix:MRS
First Name:SUYEON
Middle Name:JEON
Last Name:WANG
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4719 OREGON ACRES CV
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-7525
Mailing Address - Country:US
Mailing Address - Phone:803-730-0189
Mailing Address - Fax:
Practice Address - Street 1:4719 OREGON ACRES CV
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-7525
Practice Address - Country:US
Practice Address - Phone:803-730-0189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT13748225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist