Provider Demographics
NPI:1891024949
Name:SHIM, HEESUN GRACE (MS OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:HEESUN
Middle Name:GRACE
Last Name:SHIM
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 216TH ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-1227
Mailing Address - Country:US
Mailing Address - Phone:917-647-6308
Mailing Address - Fax:
Practice Address - Street 1:1555 216TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-1227
Practice Address - Country:US
Practice Address - Phone:917-647-6308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-21
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015805-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist