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General NPI Number Information
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NPI Number | 1194448449
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Entity Type | Organization
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Legal Business Name | BRAVO OCCUPATIONAL THERAPY PC
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Dates
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Enumeration Date | 09/21/2022
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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 |
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | JESSENIA BRAVO
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Credential | OTR/L
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Telephone | 917-847-8697
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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