MEDICARE: MRS. BICH-HANH PHAN MA, SLP-CCC, OTR-L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0200X	Pediatric Occupational Therapist	OT3036	CA
2	235Z00000X	Speech-Language Pathologist	SP11287	CA

General Provider Information

NPI Number	:	1083944417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BICH-HANH PHAN MA, SLP-CCC, OTR-L

Provider Business Mailing Address
First Line	:	3150 ALMADEN EXPY
Second Line	:	SUITE 235
City	:	SAN JOSE
State	:	CA
Zip	:	95118-1200
Country	:	US
Telephone Number	:	408-332-0259
Fax Number	:

Provider Business Practice Location Address
First Line	:	3150 ALMADEN EXPY
Second Line	:	SUITE 235
City	:	SAN JOSE
State	:	CA
Zip	:	95118-1200
Country	:	US
Telephone Number	:	408-332-0259
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/07/2010
Last Update Date	:	03/11/2015

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