Individual provider Active NPI

Joann Kim, OTR/L

  • Occupational Therapist
  • Great Neck, NY
National Provider Identifier
1710815808
Registry record updated May 18, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
031045 Issued in NY
Practice address
475 Northern Blvd Ste 19
Great Neck, NY 11021-4802
Phone
(516) 829-0030
NPI assigned
May 11, 2026
Last updated
May 18, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 18, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 031045 NY Primary

Addresses

Primary practice location

475 Northern Blvd Ste 19
Great Neck, NY 11021-4802

Mailing address

170 Fairhaven Dr Apt B15
Jericho, NY 11753-2461

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260526002402 NY Practitioner - Occupational Therapist in Private Practice 1456821941 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Occupational Therapist in Private Practice
Education
Other, 2026
Medicare assignment
May accept Medicare assignment
Group practices
Reddy Care Physical and Occupational Therapy PLLCGroup PAC ID 6103176987, 52 clinicians

Practice addresses (Care Compare)

475 Northern Blvd
Great Neck, NY 11021-4802
Phone (516) 829-0030

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
031045NYMDDental Hygienist

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1778457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779062400000",
    "number": "1710815808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "170 FAIRHAVEN DR APT B15",
            "city": "JERICHO",
            "state": "NY",
            "postal_code": "117532461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "475 NORTHERN BLVD STE 19",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110214802",
            "telephone_number": "516-829-0030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "JOANN",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-05-11",
        "last_updated": "2026-05-18",
        "certification_date": "2026-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NY",
            "license": "031045",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Great Neck, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.