Provider Demographics
NPI:1841268380
Name:HA, MAC-PHUONG THI (OTR/L, PTA, LMT)
Entity type:Individual
Prefix:
First Name:MAC-PHUONG
Middle Name:THI
Last Name:HA
Suffix:
Gender:F
Credentials:OTR/L, PTA, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4129 CLOUGH LN
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45245-1708
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3950 RED BANK RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45227-3429
Practice Address - Country:US
Practice Address - Phone:513-272-4011
Practice Address - Fax:513-271-0172
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH01910225200000X
OH33-00-9596225700000X
OHOT004675225X00000X
OH04675225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Not Answered225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand