Provider Demographics
NPI:1720809742
Name:LUCIANO, KAILAN (OTR/L)
Entity type:Individual
Prefix:
First Name:KAILAN
Middle Name:
Last Name:LUCIANO
Suffix:
Gender:F
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 1:9018 77TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421-2805
Mailing Address - Country:US
Mailing Address - Phone:917-254-5809
Mailing Address - Fax:
Practice Address - Street 1:10615 QUEENS BLVD # 11
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4301
Practice Address - Country:US
Practice Address - Phone:646-389-1161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029538225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist