Provider Demographics
NPI:1730887324
Name:WONG, KYLEE RAE (COTA/L)
Entity type:Individual
Prefix:
First Name:KYLEE
Middle Name:RAE
Last Name:WONG
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:KYLEE
Other - Middle Name:RAE
Other - Last Name:HESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7816 RACHELIS ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-5094
Mailing Address - Country:US
Mailing Address - Phone:702-592-9176
Mailing Address - Fax:
Practice Address - Street 1:7816 RACHELIS ST
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89084-5094
Practice Address - Country:US
Practice Address - Phone:702-592-9176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-22
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No171M00000XOther Service ProvidersCase Manager/Care Coordinator