Provider Demographics
NPI:1104327311
Name:BANG, ALICE (OTR)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:BANG
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:
Other - Last Name:KANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 POLARIS PKWY STE 160
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-7989
Mailing Address - Country:US
Mailing Address - Phone:818-456-8879
Mailing Address - Fax:
Practice Address - Street 1:300 POLARIS PKWY STE 160
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-7989
Practice Address - Country:US
Practice Address - Phone:614-776-0970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-22
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV18-1021225XP0200X
CAOT21269225X00000X
OHOT013142225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist