Provider Demographics
NPI:1316367535
Name:HOANG, TERESA HUYEN THI MY (COTA/L)
Entity Type:Individual
Prefix:
First Name:TERESA HUYEN
Middle Name:THI MY
Last Name:HOANG
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 FREEPORT DR
Mailing Address - Street 2:
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33404-6465
Mailing Address - Country:US
Mailing Address - Phone:321-626-8344
Mailing Address - Fax:
Practice Address - Street 1:2025 FREEPORT DR
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33404-6465
Practice Address - Country:US
Practice Address - Phone:321-626-8344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-27
Last Update Date:2014-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA11280224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant