Provider Demographics
NPI:1477815173
Name:NGO, KHIEM SAM (OTR/L)
Entity Type:Individual
Prefix:
First Name:KHIEM
Middle Name:SAM
Last Name:NGO
Suffix:
Gender:M
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 1:9222 ADOBE SKY CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-1791
Mailing Address - Country:US
Mailing Address - Phone:917-420-3565
Mailing Address - Fax:
Practice Address - Street 1:11353 SUGAR PARK LN
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-1407
Practice Address - Country:US
Practice Address - Phone:917-420-3565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-09
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017297-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist