Healthcare Provider Details

I. General information

NPI: 1346338621
Provider Name (Legal Business Name): AMY L BRZUZ OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 W 21ST ST SUITE 24
ERIE PA
16506-2972
US

IV. Provider business mailing address

2700 W 21ST ST SUITE 24
ERIE PA
16506-2972
US

V. Phone/Fax

Practice location:
  • Phone: 814-833-2301
  • Fax: 814-833-9230
Mailing address:
  • Phone: 814-833-2301
  • Fax: 814-833-9230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC005782L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: