Provider Demographics
NPI:1316585318
Name:CHU, EDDIE (OTD, OTR/L)
Entity Type:Individual
Prefix:DR
First Name:EDDIE
Middle Name:
Last Name:CHU
Suffix:
Gender:M
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 CARR DR APT 206
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-1547
Mailing Address - Country:US
Mailing Address - Phone:212-495-9799
Mailing Address - Fax:
Practice Address - Street 1:7814 ROOSEVELT AVE STE 2
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-6646
Practice Address - Country:US
Practice Address - Phone:212-495-9799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-20
Last Update Date:2024-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023809225X00000X
CA20052225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist