Provider Demographics
NPI:1174990253
Name:VANG, KAOCHI DESJHEANNETTE (MS OTR)
Entity type:Individual
Prefix:MRS
First Name:KAOCHI
Middle Name:DESJHEANNETTE
Last Name:VANG
Suffix:
Gender:F
Credentials:MS OTR
Other - Prefix:MRS
Other - First Name:KAOCHI
Other - Middle Name:DESJHEANNETTE
Other - Last Name:HER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS OTR
Mailing Address - Street 1:AURORA MEDICAL CENTER OF OSHKOSH - REHAB
Mailing Address - Street 2:855 N. WESTHAVEN DRIVE
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54904
Mailing Address - Country:US
Mailing Address - Phone:920-456-7395
Mailing Address - Fax:920-456-7101
Practice Address - Street 1:AURORA MEDICAL CENTER OF OSHKOSH - REHAB
Practice Address - Street 2:855 N. WESTHAVEN DRIVE
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904
Practice Address - Country:US
Practice Address - Phone:920-456-7395
Practice Address - Fax:920-456-7101
Is Sole Proprietor?:No
Enumeration Date:2015-08-25
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5701-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist