Provider Demographics
NPI:1790149110
Name:AN, THANH (OT)
Entity Type:Individual
Prefix:
First Name:THANH
Middle Name:
Last Name:AN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3320 STATE ROAD 436
Mailing Address - Street 2:SUITE 1010
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-6003
Mailing Address - Country:US
Mailing Address - Phone:407-703-8643
Mailing Address - Fax:407-956-2194
Practice Address - Street 1:3320 STATE ROAD 436
Practice Address - Street 2:SUITE 1010
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-6003
Practice Address - Country:US
Practice Address - Phone:407-703-8643
Practice Address - Fax:407-956-2194
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-12
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 17631225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand