Basic Information
Provider Information
NPI: 1376997387
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LE
FirstName: THUY LYNNE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: OT
OtherOrganizationName:  
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OtherLastName:  
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OtherLastNameType:  
Mailing Information
Address1: 1255 5TH AVE
Address2: 6L
City: NEW YORK
State: NY
PostalCode: 100293852
CountryCode: US
TelephoneNumber: 2123431500
FaxNumber: 2123431594
Practice Location
Address1: 1255 5TH AVE
Address2: 6L
City: NEW YORK
State: NY
PostalCode: 100293852
CountryCode: US
TelephoneNumber: 2123431500
FaxNumber: 2123431594
Other Information
ProviderEnumerationDate: 04/15/2016
LastUpdateDate: 04/15/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
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IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000X020483NYY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


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