Healthcare Provider Details

I. General information

NPI: 1699902148
Provider Name (Legal Business Name): KATHLEEN ANN BRERETON-MAK OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2009
Last Update Date: 06/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 GLEN WOOD RD
MILLWOOD NY
10546-1006
US

IV. Provider business mailing address

7 GLEN WOOD RD
MILLWOOD NY
10546-1006
US

V. Phone/Fax

Practice location:
  • Phone: 914-944-0738
  • Fax: 914-944-0738
Mailing address:
  • Phone: 914-944-0738
  • Fax: 914-944-0738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number003230-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: