Healthcare Provider Details

I. General information

NPI: 1770090912
Provider Name (Legal Business Name): BRIANA DESPIRITO TOEGEMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2018
Last Update Date: 01/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 STANTON ST
NEW YORK NY
10002-1831
US

IV. Provider business mailing address

445 E 14TH ST APT 2E
NEW YORK NY
10009-2804
US

V. Phone/Fax

Practice location:
  • Phone: 401-347-3074
  • Fax:
Mailing address:
  • Phone: 401-347-3074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number021721
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: