Provider Demographics
NPI:1447776125
Name:BAE, CHRISTY YOUNG MI (OTR)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:YOUNG MI
Last Name:BAE
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 1:605 E 14TH ST APT 9F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-3205
Mailing Address - Country:US
Mailing Address - Phone:626-731-4762
Mailing Address - Fax:
Practice Address - Street 1:605 E 14TH ST APT 9F
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-3205
Practice Address - Country:US
Practice Address - Phone:626-731-4762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-15
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021445225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist