Provider Demographics
NPI:1124051859
Name:AUNG, CARISSA J (OTR/L)
Entity type:Individual
Prefix:
First Name:CARISSA
Middle Name:J
Last Name:AUNG
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 1:28991 OLD TOWN FRONT ST
Mailing Address - Street 2:STE 201
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-5803
Mailing Address - Country:US
Mailing Address - Phone:951-506-9800
Mailing Address - Fax:951-506-4245
Practice Address - Street 1:28991 OLD TOWN FRONT ST
Practice Address - Street 2:STE 201
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-5803
Practice Address - Country:US
Practice Address - Phone:951-506-9800
Practice Address - Fax:951-506-4245
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT5083225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Not Answered225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOT0050830OtherBLUE SHIELD PIN
CACT0050830Medicaid
CAZZZ03280ZMedicare ID - Type Unspecified