Healthcare Provider Details

I. General information

NPI: 1841845914
Provider Name (Legal Business Name): MICHELLE NGUYEN VO MOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE HANG NGUYEN

II. Dates (important events)

Enumeration Date: 08/06/2019
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9421 STONEBROOK DR
ELK GROVE CA
95624-6089
US

IV. Provider business mailing address

9421 STONEBROOK DR
ELK GROVE CA
95624-6089
US

V. Phone/Fax

Practice location:
  • Phone: 916-714-5520
  • Fax: 916-714-5588
Mailing address:
  • Phone: 916-714-5520
  • Fax: 916-714-5588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number18615
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: