Provider Demographics
NPI:1689114076
Name:KIM, EMMA (OTR/L, CLT)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:OTR/L, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4326 165TH ST
Mailing Address - Street 2:APT 3H
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-3257
Mailing Address - Country:US
Mailing Address - Phone:914-434-3006
Mailing Address - Fax:
Practice Address - Street 1:119 W 57TH ST STE 212
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-2302
Practice Address - Country:US
Practice Address - Phone:212-421-5505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-03
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020985225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist