Provider Demographics
NPI:1457466740
Name:PHONGPAICHIT, DOUNGPAN (OTR)
Entity Type:Individual
Prefix:
First Name:DOUNGPAN
Middle Name:
Last Name:PHONGPAICHIT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 OHIO DRIVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093
Mailing Address - Country:US
Mailing Address - Phone:972-599-9594
Mailing Address - Fax:972-599-9364
Practice Address - Street 1:1101 OHIO DRIVE
Practice Address - Street 2:SUITE 105
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093
Practice Address - Country:US
Practice Address - Phone:972-599-9594
Practice Address - Fax:972-599-9364
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111926225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K5183Medicare PIN
TX4724960001Medicare NSC