Healthcare Provider Details

I. General information

NPI: 1548415391
Provider Name (Legal Business Name): LISA C BRUNO OCCUPATIONAL THERAPY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2008
Last Update Date: 11/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

182 RT. 117 BYBASS RD
BEDFORD HILLS NY
10507
US

IV. Provider business mailing address

P.O. BOX 158
BEDFORD HILLS NY
10507
US

V. Phone/Fax

Practice location:
  • Phone: 914-774-1073
  • Fax: 914-666-2238
Mailing address:
  • Phone: 914-666-2235
  • Fax: 914-666-2238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number0101161
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: