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General NPI Number Information
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NPI Number | 1275337198
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Entity Type | Individual
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Provider Name | MS. IVANA MY-KIEU LE
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Gender | Female
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Dates
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Enumeration Date | 04/01/2025
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | 4500 13TH ST STE 900
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City | GULFPORT
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State | MS
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Zip | 39501-2515
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Country | US
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Telephone | 228-822-6965
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Fax |
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Provider Business Mailing Address
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Address Line | 2400 RHONDA AVE
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City | OCEAN SPRINGS
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State | MS
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Zip | 39564-3785
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Country | US
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Telephone | 228-297-9914
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 3655
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 3977
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License Number State | MS
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