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General NPI Number Information
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NPI Number | 1750260576
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Entity Type | Individual
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Provider Name | ELIZABETH KIM NGUYEN OTR/L
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Gender | Female
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Dates
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Enumeration Date | 08/27/2025
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Last Update Date | 08/27/2025
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Provider Practice Location Address
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Address Line | 5301 W EVERETT M DIRKSEN PKWY
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City | PEORIA
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State | IL
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Zip | 61607-1126
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Country | US
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Telephone | 309-681-5995
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Fax |
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Provider Business Mailing Address
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Address Line | 16118 W PLEASANT GROVE RD
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City | TRIVOLI
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State | IL
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Zip | 61569-9751
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Country | US
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Telephone | 952-688-3217
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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