Provider Demographics
NPI:1154841864
Name:LUONG, JAMIE (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:LUONG
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 1:1079 TULARE DR
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-2112
Mailing Address - Country:US
Mailing Address - Phone:714-657-4732
Mailing Address - Fax:
Practice Address - Street 1:12131 BROOKHURST ST
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-2863
Practice Address - Country:US
Practice Address - Phone:714-360-8828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-23
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist