Healthcare Provider Details
I. General information
NPI: 1376050633
Provider Name (Legal Business Name): MICHAEL ANG OTD, OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 01/08/2018
Last Update Date: 01/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
500 N ROSEMEAD BLVD APT 30
PASADENA CA
91107-2143
US
IV. Provider business mailing address
500 N ROSEMEAD BLVD APT 30
PASADENA CA
91107-2143
US
V. Phone/Fax
- Phone: 323-540-2343
- Fax:
- Phone: 323-540-2343
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 225X00000X |
| Taxonomy | Occupational Therapist |
| License Number | 11022 |
| License Number State | CA |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 225XE1200X |
| Taxonomy | Ergonomics Occupational Therapist |
| License Number | 11022 |
| License Number State | CA |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 225XH1200X |
| Taxonomy | Hand Occupational Therapist |
| License Number | 11022 |
| License Number State | CA |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 225XH1300X |
| Taxonomy | Human Factors Occupational Therapist |
| License Number | 11022 |
| License Number State | CA |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 225XN1300X |
| Taxonomy | Neurorehabilitation Occupational Therapist |
| License Number | 11022 |
| License Number State | CA |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 225XP0200X |
| Taxonomy | Pediatric Occupational Therapist |
| License Number | 11022 |
| License Number State | CA |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 225XR0403X |
| Taxonomy | Driving and Community Mobility Occupational Therapist |
| License Number | 11022 |
| License Number State | CA |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 225XG0600X |
| Taxonomy | Gerontology Occupational Therapist |
| License Number | 11022 |
| License Number State | CA |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 225XM0800X |
| Taxonomy | Mental Health Occupational Therapist |
| License Number | 11022 |
| License Number State | CA |
| # 10 | |
| Primary Taxonomy | N |
| Taxonomy Code | 225XP0019X |
| Taxonomy | Physical Rehabilitation Occupational Therapist |
| License Number | 11022 |
| License Number State | CA |
| # 11 | |
| Primary Taxonomy | N |
| Taxonomy Code | 225XE0001X |
| Taxonomy | Environmental Modification Occupational Therapist |
| License Number | 11022 |
| License Number State | CA |
| # 12 | |
| Primary Taxonomy | N |
| Taxonomy Code | 225XF0002X |
| Taxonomy | Feeding, Eating & Swallowing Occupational Therapist |
| License Number | 11022 |
| License Number State | CA |
| # 13 | |
| Primary Taxonomy | N |
| Taxonomy Code | 225XL0004X |
| Taxonomy | Low Vision Occupational Therapist |
| License Number | 11022 |
| License Number State | CA |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
