Healthcare Provider Details

I. General information

NPI: 1073498598
Provider Name (Legal Business Name): HANNAH OTELIA BROCKMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2025
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 E 121ST ST FL 5
NEW YORK NY
10035-3523
US

IV. Provider business mailing address

198 E 121ST ST FL 5
NEW YORK NY
10035-3523
US

V. Phone/Fax

Practice location:
  • Phone: 212-803-5892
  • Fax: 646-335-0672
Mailing address:
  • Phone: 212-803-5892
  • Fax: 646-335-0672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number030391
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: