Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT5836 | FL |
N | 225XP0200X | Occupational Therapist - Pediatrics | OT 5836 | FL |
NPI | 1033226865 |
---|---|
Provider Name | Lan Nguyen Cassella |
First Address | Tampa, FL 33607-1129 |
Second Address | Tampa, FL 33607-1129 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2006 |
Last Update Date | 21/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
885649400 | (05) | FL |