Provider Demographics
NPI:1447996384
Name:FONG, TAYLOR (OTD, OTR/L)
Entity type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:
Last Name:FONG
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1170 KAUMAILUNA PL
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-1516
Mailing Address - Country:US
Mailing Address - Phone:808-232-8732
Mailing Address - Fax:
Practice Address - Street 1:725 KAPIOLANI BLVD STE C206
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-6024
Practice Address - Country:US
Practice Address - Phone:808-596-0099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOT-2220225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist