Provider Demographics
NPI:1104010750
Name:NGUYEN, HONG HA THI (OTR/L)
Entity Type:Individual
Prefix:
First Name:HONG HA
Middle Name:THI
Last Name:NGUYEN
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 1:407 CROYDEN RD
Mailing Address - Street 2:
Mailing Address - City:CHELTENHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19012-1611
Mailing Address - Country:US
Mailing Address - Phone:215-379-1414
Mailing Address - Fax:215-698-2749
Practice Address - Street 1:10400 ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-3905
Practice Address - Country:US
Practice Address - Phone:215-698-5641
Practice Address - Fax:215-698-2749
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC006645L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist