Provider Demographics
NPI:1134485949
Name:RYDER, CAROL J (OTR)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:J
Last Name:RYDER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 5TH AVE
Mailing Address - Street 2:OT ROOM
Mailing Address - City:NY
Mailing Address - State:NY
Mailing Address - Zip Code:10037-3702
Mailing Address - Country:US
Mailing Address - Phone:212-690-5936
Mailing Address - Fax:212-690-5939
Practice Address - Street 1:2121 5TH AVE
Practice Address - Street 2:OT ROOM
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-3702
Practice Address - Country:US
Practice Address - Phone:212-690-5936
Practice Address - Fax:212-690-5939
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003370-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist