Provider Demographics
NPI:1982085692
Name:GOYAL, YASUYO (OTR/L)
Entity Type:Individual
Prefix:
First Name:YASUYO
Middle Name:
Last Name:GOYAL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 E 57TH ST APT 39E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-2095
Mailing Address - Country:US
Mailing Address - Phone:646-418-5607
Mailing Address - Fax:
Practice Address - Street 1:117 E 57TH ST APT 39E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-2095
Practice Address - Country:US
Practice Address - Phone:646-418-5607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012606-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist