MEDICARE: WAN YAO AMANDA KO MSOTR/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	028379-01	NY

General Provider Information

NPI Number	:	1740053206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WAN YAO AMANDA KO MSOTR/L

Provider Business Mailing Address
First Line	:	7914 150TH ST
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11367-3848
Country	:	US
Telephone Number	:	718-878-0046
Fax Number	:

Provider Business Practice Location Address
First Line	:	7914 150TH ST
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11367-3848
Country	:	US
Telephone Number	:	718-878-0046
Fax Number	:

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

Provider Enumeration Date	:	11/06/2023
Last Update Date	:	11/06/2023

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