Provider Demographics
NPI:1861917684
Name:JOACHIM, KRISADEL C (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:KRISADEL
Middle Name:C
Last Name:JOACHIM
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KRISADEL
Other - Middle Name:C
Other - Last Name:ESPIRITU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:5 PLITT AVENUE
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735
Mailing Address - Country:US
Mailing Address - Phone:917-209-2718
Mailing Address - Fax:
Practice Address - Street 1:5 PLITT AVE
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-5102
Practice Address - Country:US
Practice Address - Phone:917-209-2718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-14
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY21544225XP0019X, 225XP0200X, 225X00000X
NY8296225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant