Provider Demographics
NPI:1639594674
Name:PHAM, TRANG THUY (OTA)
Entity Type:Individual
Prefix:
First Name:TRANG
Middle Name:THUY
Last Name:PHAM
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 NORTHGLEN ST
Mailing Address - Street 2:
Mailing Address - City:MCPHERSON
Mailing Address - State:KS
Mailing Address - Zip Code:67460-2746
Mailing Address - Country:US
Mailing Address - Phone:620-480-1303
Mailing Address - Fax:
Practice Address - Street 1:1408 NORTHGLEN ST
Practice Address - Street 2:
Practice Address - City:MCPHERSON
Practice Address - State:KS
Practice Address - Zip Code:67460-2746
Practice Address - Country:US
Practice Address - Phone:620-480-1303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-27
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST-03863224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant