Individual provider Active NPI

Judy Chan, OTR/R

  • Occupational Therapist
  • Brooklyn, NY
National Provider Identifier
1427532241
Registry record updated Sep 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
408533 Issued in NY
Practice address
16 Sumner PL
Brooklyn, NY 11206-4110
Phone
(718) 336-9500
NPI assigned
Sep 18, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Rehabilitation Occupational Therapist 225XP0019X 408533 NY
Pediatric Occupational Therapist 225XP0200X 408533 NY
Occupational Therapist 225X00000X 408533 NY Primary

Addresses

Primary practice location

16 Sumner PL
Brooklyn, NY 11206-4110

Mailing address

2033 W 12TH St FL 1
Brooklyn, NY 11223-3532
Phone (347) 797-9833

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220602000200 TX Practitioner - Occupational Therapist in Private Practice 0042563256 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
408533NYMDPediatric Occupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Fox Rehabilitation Services TX LLC Occupational Therapist CurrentSince Nov 1, 2024 Accepting new patients

Locations

4101 W Arkansas Ln
Arlington, TX 76016
Phone (817) 469-7671

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1537228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537228800000",
    "number": "1427532241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2033 W 12TH ST FL 1",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112233532",
            "telephone_number": "347-797-9833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16 SUMNER PL",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112064110",
            "telephone_number": "718-336-9500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAN",
        "first_name": "JUDY",
        "credential": "OTR/R",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-18",
        "last_updated": "2018-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0019X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Physical Rehabilitation",
            "state": "NY",
            "license": "408533",
            "primary": false
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "NY",
            "license": "408533",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NY",
            "license": "408533",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.