Healthcare Provider Details

I. General information

NPI: 1699907808
Provider Name (Legal Business Name): NINO RICHIE CHIANG LEETIAN OT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2009
Last Update Date: 12/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7030 EVERGREEN WOODS TRL
SPRING HILL FL
34608-1305
US

IV. Provider business mailing address

3614 CARROLLWOOD PLACE CIR APT. 202
TAMPA FL
33624-3070
US

V. Phone/Fax

Practice location:
  • Phone: 352-610-4475
  • Fax:
Mailing address:
  • Phone: 706-980-1864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License NumberOT004476
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT14185
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: