Healthcare Provider Details

I. General information

NPI: 1104327311
Provider Name (Legal Business Name): ALICE BANG OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALICE KANG

II. Dates (important events)

Enumeration Date: 02/22/2018
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 POLARIS PKWY STE 160
WESTERVILLE OH
43082-7989
US

IV. Provider business mailing address

300 POLARIS PKWY STE 160
WESTERVILLE OH
43082-7989
US

V. Phone/Fax

Practice location:
  • Phone: 614-776-0970
  • Fax:
Mailing address:
  • Phone: 818-456-8879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number18-1021
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT21269
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT013142
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: