Provider Demographics
NPI:1336604156
Name:KINHA-FANDOHAN, FLORA HASSY
Entity Type:Individual
Prefix:
First Name:FLORA
Middle Name:HASSY
Last Name:KINHA-FANDOHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2803 RUTLAND CIR UNIT 103
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-4997
Mailing Address - Country:US
Mailing Address - Phone:708-663-1337
Mailing Address - Fax:
Practice Address - Street 1:2803 RUTLAND CIR UNIT 103
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-4997
Practice Address - Country:US
Practice Address - Phone:708-663-1337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-06
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL56009624225XP0019X
225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation