Active NPI
Xiao Tan, COTA
- Occupational Therapy Assistant
- Elmhurst, NY
National Provider Identifier
1770362907
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 011370
- Practice address
- 5205 94TH St
Elmhurst, NY 11373-4609 - Phone
- (929) 888-2691
- NPI assigned
- Sep 26, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 011370 | NY | Primary |
Addresses
Primary practice location
5205 94TH St
Elmhurst, NY 11373-4609
Mailing address
5205 94TH St
Elmhurst, NY 11373-4609
Phone (929) 888-2691
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 011370 | NY | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1695686400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1695686400000",
"number": "1770362907",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5205 94TH ST",
"city": "ELMHURST",
"state": "NY",
"postal_code": "113734609",
"telephone_number": "929-888-2691"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5205 94TH ST",
"city": "ELMHURST",
"state": "NY",
"postal_code": "113734609",
"telephone_number": "929-888-2691"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAN",
"first_name": "XIAO",
"credential": "COTA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-09-26",
"last_updated": "2023-09-26",
"certification_date": "2023-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Occupational Therapy Assistant",
"state": "NY",
"license": "011370",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elmhurst, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.