Provider Demographics
NPI:1194951970
Name:WONG, KATTI (MOT)
Entity type:Individual
Prefix:
First Name:KATTI
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11785 NORTHFALL LN STE 502
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-7961
Mailing Address - Country:US
Mailing Address - Phone:678-520-6879
Mailing Address - Fax:770-569-7432
Practice Address - Street 1:11785 NORTHFALL LN STE 502
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-7961
Practice Address - Country:US
Practice Address - Phone:678-520-6879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-06
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004852225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA004852OtherOCCUPATIONAL THERAPY LICENSE