Provider Demographics
NPI:1134719727
Name:DANG, KATHLEEN VAN KHANH (OTR/L)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:VAN KHANH
Last Name:DANG
Suffix:
Gender:F
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 1:2291 ANNANDALE PL
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-9122
Mailing Address - Country:US
Mailing Address - Phone:937-716-0054
Mailing Address - Fax:
Practice Address - Street 1:264 WILMINGTON AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45420-1989
Practice Address - Country:US
Practice Address - Phone:937-256-4663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT011314225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist