MEDICARE: JOYCE WOOKYUNG STARR OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	DH87369	MA
2	225X00000X	Occupational Therapist	022413	NY

General Provider Information

NPI Number	:	1285935742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOYCE WOOKYUNG STARR OTR/L

Provider Business Mailing Address
First Line	:	1500 ROUTE 208
Second Line	:
City	:	WALLKILL
State	:	NY
Zip	:	12589-3712
Country	:	US
Telephone Number	:	845-895-7100
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 ROUTE 208
Second Line	:
City	:	WALLKILL
State	:	NY
Zip	:	12589-3712
Country	:	US
Telephone Number	:	845-895-7100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2010
Last Update Date	:	03/22/2021

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