Healthcare Provider Details

I. General information

NPI: 1679884407
Provider Name (Legal Business Name): SUSAN BRAHAM OTR-L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2010
Last Update Date: 06/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TIFFANY PL APT 5G
BROOKLYN NY
11231-2949
US

IV. Provider business mailing address

1 TIFFANY PL APT 5G
BROOKLYN NY
11231-2949
US

V. Phone/Fax

Practice location:
  • Phone: 347-731-6901
  • Fax: 718-624-7410
Mailing address:
  • Phone: 347-731-6901
  • Fax: 718-624-7410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number6527
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number16132
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: