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NPI Code Detail

MEDICARE: JOANN KIM OTR/L

MEDICARE: JOANN KIM 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
1225X00000XOccupational Therapist031045NY

General Provider Information

NPI Number : 1710815808
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOANN KIM OTR/L
Provider Business Mailing Address
First Line : 170 FAIRHAVEN DR APT B15
Second Line :
City : JERICHO
State : NY
Zip : 11753-2461
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 475 NORTHERN BLVD STE 19
Second Line :
City : GREAT NECK
State : NY
Zip : 11021-4802
Country : US
Telephone Number : 516-829-0030
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2026
Last Update Date : 05/18/2026

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Directions to “ JOANN KIM OTR/L” Practice Location

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