Provider Demographics
NPI:1871094516
Name:LEE, KYU CHUL (OTR/L)
Entity type:Individual
Prefix:
First Name:KYU CHUL
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 W 61ST ST APT 4H
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-7401
Mailing Address - Country:US
Mailing Address - Phone:347-720-4320
Mailing Address - Fax:
Practice Address - Street 1:3059 BRIGHTON 7TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-6455
Practice Address - Country:US
Practice Address - Phone:718-676-5252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022265225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist