MEDICARE: ADA L CHAN 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	225X00000X	Occupational Therapist	030676	NY

General Provider Information

NPI Number	:	1417817636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADA L CHAN OTR/L

Provider Business Mailing Address
First Line	:	3636 10TH ST
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11106-5112
Country	:	US
Telephone Number	:	718-353-1785
Fax Number	:

Provider Business Practice Location Address
First Line	:	3636 10TH ST
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11106-5112
Country	:	US
Telephone Number	:	718-383-1785
Fax Number	:

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

Provider Enumeration Date	:	11/12/2025
Last Update Date	:	03/10/2026

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