Individual
XIAO TAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
5205 94TH ST, ELMHURST, NY 11373-4609
(929) 888-2691
Mailing address
5205 94TH ST, ELMHURST, NY 11373-4609
(929) 888-2691
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
011370
NY
Other
Enumeration date
09/26/2023
Last updated
09/26/2023
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