Provider Demographics
NPI:1497063390
Name:RYAN, MICHAEL (MS,OTR/L)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:RYAN
Suffix:
Gender:M
Credentials:MS,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 E 12TH ST
Mailing Address - Street 2:APT 1K
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-7203
Mailing Address - Country:US
Mailing Address - Phone:917-656-5214
Mailing Address - Fax:212-685-3224
Practice Address - Street 1:250 5TH AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6405
Practice Address - Country:US
Practice Address - Phone:212-685-3266
Practice Address - Fax:212-685-3224
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014646-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist