Provider Demographics
NPI:1881262814
Name:VUONG, TAI PATRICK (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:TAI
Middle Name:PATRICK
Last Name:VUONG
Suffix:
Gender:M
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 YORKTOWN ROAD
Mailing Address - Street 2:
Mailing Address - City:WOOLWICH TWP
Mailing Address - State:GLOUCESTER
Mailing Address - Zip Code:08085
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5113 MAUNALANI CIR
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-4019
Practice Address - Country:US
Practice Address - Phone:808-732-0771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEU1-0012249225X00000X
NJ46TR00978300225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJQ1S123302441001OtherAMERIHEALTH