Provider Demographics
NPI:1558582031
Name:NGUYEN, LOAN (MS, OTR, CIMI)
Entity Type:Individual
Prefix:
First Name:LOAN
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MS, OTR, CIMI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 BRIXWORTH PL NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30319
Mailing Address - Country:US
Mailing Address - Phone:404-421-5461
Mailing Address - Fax:404-325-7232
Practice Address - Street 1:1202 BRIXWORTH PL NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30319
Practice Address - Country:US
Practice Address - Phone:404-421-5461
Practice Address - Fax:404-325-7232
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003468225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA549575226AMedicaid