Provider Demographics
NPI:1649095449
Name:CHAN, KAYLA (ORT/L)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
Credentials:ORT/L
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:1600 HALF MOON BAY DR
Mailing Address - Street 2:
Mailing Address - City:CROTON ON HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:10520-3120
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:725 LEONARD ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-2350
Practice Address - Country:US
Practice Address - Phone:347-472-4792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
522529OtherNBCOT
NY029655OtherNY DEPARTMENT OF EDUCATION