Healthcare Provider Details

I. General information

NPI: 1033226865
Provider Name (Legal Business Name): LAN NGUYEN CASSELLA OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAN PHUONG NGUYEN

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 04/21/2021
Certification Date: 03/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3421 W LEROY ST
TAMPA FL
33607-1129
US

IV. Provider business mailing address

3421 W LEROY ST
TAMPA FL
33607-1129
US

V. Phone/Fax

Practice location:
  • Phone: 813-846-5089
  • Fax: 813-441-8121
Mailing address:
  • Phone: 813-846-5089
  • Fax: 813-441-8121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT5836
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT 5836
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: