Basic Information
| Provider Information | |||||||||
| NPI: | 1821768037 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EGAN | ||||||||
| FirstName: | KYM | ||||||||
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| Credential: | OTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 MAIN ST STE 505 | ||||||||
| Address2: | |||||||||
| City: | EATONTOWN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077243903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7324933100 | ||||||||
| FaxNumber: | 7328764967 | ||||||||
| Practice Location | |||||||||
| Address1: | 296 HAMBURG TPKE | ||||||||
| Address2: | |||||||||
| City: | WAYNE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074702150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9737905800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2021 | ||||||||
| LastUpdateDate: | 09/18/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 46TR01013600 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.