Basic Information
| Provider Information | |||||||||
| NPI: | 1841845914 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NGUYEN | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | MOT,OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6960 DESTINY DR STE 112 | ||||||||
| Address2: | |||||||||
| City: | ROCKLIN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956772995 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164150119 | ||||||||
| FaxNumber: | 9164150120 | ||||||||
| Practice Location | |||||||||
| Address1: | 6960 DESTINY DR STE 112 | ||||||||
| Address2: | |||||||||
| City: | ROCKLIN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956772995 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164150119 | ||||||||
| FaxNumber: | 9164150120 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2019 | ||||||||
| LastUpdateDate: | 08/06/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 18615 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.