Provider Demographics
NPI:1679873103
Name:CHAN, LILY (OTR/L)
Entity Type:Individual
Prefix:
First Name:LILY
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 BRONX PARK E
Mailing Address - Street 2:APT. 3B
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-2265
Mailing Address - Country:US
Mailing Address - Phone:917-238-2216
Mailing Address - Fax:
Practice Address - Street 1:2100 BRONX PARK E
Practice Address - Street 2:APT. 3B
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-2265
Practice Address - Country:US
Practice Address - Phone:917-238-2216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016187-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist