Provider Demographics
NPI:1518446277
Name:PHAM, PHUONG EMILY (OTL)
Entity Type:Individual
Prefix:
First Name:PHUONG
Middle Name:EMILY
Last Name:PHAM
Suffix:
Gender:F
Credentials:OTL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 HOLLOW TREE LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-2803
Mailing Address - Country:US
Mailing Address - Phone:832-705-8700
Mailing Address - Fax:832-705-8701
Practice Address - Street 1:303 HOLLOW TREE LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2803
Practice Address - Country:US
Practice Address - Phone:832-705-8700
Practice Address - Fax:832-705-8701
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111993225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist