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General NPI Number Information
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NPI Number | 1174006175
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Entity Type | Individual
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Provider Name | JESSENIA BRAVO
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Gender | Female
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Dates
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Enumeration Date | 09/14/2018
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Last Update Date | 11/08/2023
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Provider Practice Location Address
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Address Line | 111 W OLD COUNTRY RD
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City | HICKSVILLE
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State | NY
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Zip | 11801-4036
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Country | US
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Telephone | 516-433-4570
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Fax |
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Provider Business Mailing Address
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Address Line | 104 MEISTER BLVD
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City | FREEPORT
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State | NY
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Zip | 11520-5919
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Country | US
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Telephone | 917-847-8697
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Fax | 516-440-4932
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XG0600X
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Taxonomy Name | Gerontology Occupational Therapist
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License Number | 022682-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225XN1300X
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Taxonomy Name | Neurorehabilitation Occupational Therapist
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License Number | 022682-1
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 225XP0019X
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Taxonomy Name | Physical Rehabilitation Occupational Therapist
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License Number | 022682-1
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 022682-1
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License Number State | NY
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