=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376977124
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANNE L SANTOS NGHIEM OT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2013
-----------------------------------------------------
Last Update Date | 08/29/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16223 DEVONSHIRE ST
-----------------------------------------------------
City | GRANADA HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91344-6910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-831-2400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6670 GLADE AVE 219
-----------------------------------------------------
City | WOODLAND HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91303-2541
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-324-7285
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | OT7608
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------