Healthcare Provider Details

I. General information

NPI: 1184298937
Provider Name (Legal Business Name): ANDY THAI MSOT, OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2021
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8113 CERRITOS AVE APT 65
STANTON CA
90680-2482
US

IV. Provider business mailing address

8113 CERRITOS AVE APT 65
STANTON CA
90680-2482
US

V. Phone/Fax

Practice location:
  • Phone: 949-241-3073
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number28820
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: