Individual
MISS KIM LAVERNE WONGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C.O.T.A
Contact information
Practice address
9777 QUEENS BLVD, PENTHOUSE, REGO PARK, NY 11374-3335
(718) 830-9253
Mailing address
9777 QUEENS BLVD, PENTHOUSE, REGO PARK, NY 11374-3335
(718) 830-9253
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
001948-1
NY
Other
Enumeration date
06/26/2012
Last updated
06/26/2012
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