MEDICARE: MAI NGUYEN OTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Z00000X	Occupational Therapy Assistant	OTA.Z20382	LA

General Provider Information

NPI Number	:	1912524075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAI NGUYEN OTA

Provider Business Mailing Address
First Line	:	4021 CADILLAC ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70122-1116
Country	:	US
Telephone Number	:	504-246-7900
Fax Number	:	504-246-6570

Provider Business Practice Location Address
First Line	:	4021 CADILLAC ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70122-1116
Country	:	US
Telephone Number	:	504-246-7900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2020
Last Update Date	:	07/06/2020

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Directions to “ MAI NGUYEN OTA” Practice Location

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