Provider Demographics
NPI:1982004495
Name:KINDRED SPIRITS OCCUPATIONAL THERAPY PLLC
Entity Type:Organization
Organization Name:KINDRED SPIRITS OCCUPATIONAL THERAPY PLLC
Other - Org Name:KINDRED SPIRITS OT PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OCCUPATIONAL THERAPY
Authorized Official - Prefix:MR
Authorized Official - First Name:MUN
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHIEH
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:917-362-2018
Mailing Address - Street 1:69-14 183RD STREET FRESH MEADOWS
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:11365
Mailing Address - Country:US
Mailing Address - Phone:917-362-2018
Mailing Address - Fax:
Practice Address - Street 1:4160 MAIN ST STE 209B
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3899
Practice Address - Country:US
Practice Address - Phone:917-933-8503
Practice Address - Fax:917-463-1056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-03
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY63017967225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG100361058Medicare PIN
NYA100116209Medicare PIN