Provider Demographics
NPI:1104464510
Name:WING, NATALIE M (OTR/L)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:M
Last Name:WING
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4548 OXBOW DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-0830
Mailing Address - Country:US
Mailing Address - Phone:916-402-5581
Mailing Address - Fax:
Practice Address - Street 1:5270 ELVAS AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-2332
Practice Address - Country:US
Practice Address - Phone:916-382-9546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16139225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist