Healthcare Provider Details

I. General information

NPI: 1952880387
Provider Name (Legal Business Name): JENNIFER VUONG OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2018
Last Update Date: 08/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3160 GUS THOMASSON RD
MESQUITE TX
75150-4048
US

IV. Provider business mailing address

3801 JEANETTE LN
MCKINNEY TX
75071-2436
US

V. Phone/Fax

Practice location:
  • Phone: 469-329-4002
  • Fax:
Mailing address:
  • Phone: 469-288-9043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number118100
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: