Healthcare Provider Details

I. General information

NPI: 1780214924
Provider Name (Legal Business Name): YAM CHAN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JASMINE CHAN OTR/L

II. Dates (important events)

Enumeration Date: 01/16/2020
Last Update Date: 01/16/2020
Certification Date: 01/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6405 KILBROGAN CT
CLARKSVILLE MD
21029-1294
US

IV. Provider business mailing address

6405 KILBROGAN CT
CLARKSVILLE MD
21029-1294
US

V. Phone/Fax

Practice location:
  • Phone: 410-948-0061
  • Fax:
Mailing address:
  • Phone: 410-948-0061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225XR0403X
TaxonomyDriving and Community Mobility Occupational Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: