Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics |
NPI | 1033421177 |
---|---|
Provider Name | Mr. Kenneth Chan |
First Address | Forest Hills, NY 11375-3611 |
Second Address | Brooklyn, NY 11211-9210 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2010 |
Last Update Date | 06/07/2010 |