Healthcare Provider Details

I. General information

NPI: 1710699178
Provider Name (Legal Business Name): ANNETTE BRESLER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2022
Last Update Date: 12/16/2022
Certification Date: 12/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3767 HYLAN BLVD
STATEN ISLAND NY
10308-3505
US

IV. Provider business mailing address

167 MCCLEAN AVE
STATEN ISLAND NY
10305-4648
US

V. Phone/Fax

Practice location:
  • Phone: 347-465-7180
  • Fax:
Mailing address:
  • Phone: 646-299-7196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number027529
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: