Provider Demographics
NPI:1912524075
Name:NGUYEN, MAI (OTA)
Entity Type:Individual
Prefix:
First Name:MAI
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4021 CADILLAC ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-1116
Mailing Address - Country:US
Mailing Address - Phone:504-246-7900
Mailing Address - Fax:504-246-6570
Practice Address - Street 1:4021 CADILLAC ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70122-1116
Practice Address - Country:US
Practice Address - Phone:504-246-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTA.Z20382224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant