Provider Demographics
NPI:1780214924
Name:CHAN, YAM (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:YAM
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:JASMINE
Other - Middle Name:
Other - Last Name:CHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:6405 KILBROGAN CT
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-1294
Mailing Address - Country:US
Mailing Address - Phone:410-948-0061
Mailing Address - Fax:
Practice Address - Street 1:6405 KILBROGAN CT
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21029-1294
Practice Address - Country:US
Practice Address - Phone:410-948-0061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
No225XR0403XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistDriving and Community Mobility