Healthcare Provider Details

I. General information

NPI: 1710299011
Provider Name (Legal Business Name): SACHA KHALOYAN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2010
Last Update Date: 07/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 E 24TH ST
NEW YORK NY
10010-4019
US

IV. Provider business mailing address

200 OLD PALISADE RD APARTMENT 22B
FORT LEE NJ
07024-7056
US

V. Phone/Fax

Practice location:
  • Phone: 212-585-6115
  • Fax:
Mailing address:
  • Phone: 201-575-2134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number016183
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: