Provider Demographics
NPI:1497491815
Name:KIM, RACHEL Y (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:Y
Last Name:KIM
Suffix:
Gender:F
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 1:100 STATE ST APT 429
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-5496
Mailing Address - Country:US
Mailing Address - Phone:201-661-3950
Mailing Address - Fax:
Practice Address - Street 1:2509 PARK AVE STE 2C
Practice Address - Street 2:
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-5300
Practice Address - Country:US
Practice Address - Phone:908-205-8246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00962500225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist