Individual
INKOO SONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
11409 N CENTRAL EXPY, DALLAS, TX 75243-6678
(214) 239-5728
Mailing address
1057 LAKE RIDGE DR, RICHARDSON, TX 75081-5155
(940) 636-1725
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
210350
TX
Other
Enumeration date
06/28/2019
Last updated
06/28/2019
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