Healthcare Provider Details

I. General information

NPI: 1205790680
Provider Name (Legal Business Name): JUDY KYIN OTR/L, MA, MS, DOMTP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 MADISON AVE FL 8
NEW YORK NY
10016-2418
US

IV. Provider business mailing address

260 MADISON AVE FL 8
NEW YORK NY
10016-2418
US

V. Phone/Fax

Practice location:
  • Phone: 917-957-0759
  • Fax:
Mailing address:
  • Phone: 917-957-0759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number015939-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: