Healthcare Provider Details

I. General information

NPI: 1831939685
Provider Name (Legal Business Name): BRITNEY EISENZAPF COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2024
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 MONTAUK HWY
OAKDALE NY
11769-1492
US

IV. Provider business mailing address

43 CRESTWOOD LN
FARMINGVILLE NY
11738-1036
US

V. Phone/Fax

Practice location:
  • Phone: 631-218-1545
  • Fax:
Mailing address:
  • Phone: 631-681-2622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number011523-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: