MEDICARE: JOY KO

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	027056	NY

General Provider Information

NPI Number	:	1437872967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOY KO

Provider Business Mailing Address
First Line	:	210 E 29TH ST APT PHA
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10016-8532
Country	:	US
Telephone Number	:	443-766-0882
Fax Number	:

Provider Business Practice Location Address
First Line	:	131 W 135TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10030-2922
Country	:	US
Telephone Number	:	212-678-2200
Fax Number	:

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

Provider Enumeration Date	:	09/20/2022
Last Update Date	:	09/20/2022

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