Provider Demographics
NPI:1932794146
Name:ABOVE AND BEYOND KIDS OT PC
Entity Type:Organization
Organization Name:ABOVE AND BEYOND KIDS OT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:SUN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:917-916-8956
Mailing Address - Street 1:3815 149TH ST APT 4V
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-6303
Mailing Address - Country:US
Mailing Address - Phone:917-916-8956
Mailing Address - Fax:
Practice Address - Street 1:3815 149TH ST APT 4V
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-6303
Practice Address - Country:US
Practice Address - Phone:917-916-8956
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-09
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency