Individual
PACHA VANG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
13900 W BURLEIGH RD, BROOKFIELD, WI 53005-3019
(262) 781-0550
Mailing address
PO BOX 1034, BROOKFIELD, WI 53008-1034
(262) 264-8789
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8618005
8618005
WI
Enumeration date
03/29/2021
Last updated
02/15/2022
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