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General NPI Number Information
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NPI Number | 1366105397
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Entity Type | Individual
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Provider Name | DENISE NICOLE BREAULT OTA
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Gender | Female
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Dates
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Enumeration Date | 10/17/2021
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Last Update Date | 10/17/2021
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Provider Practice Location Address
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Address Line | 38 PROSPECT AVE
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City | CATSKILL
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State | NY
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Zip | 12414-1514
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Country | US
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Telephone | 518-943-5701
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Fax |
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Provider Business Mailing Address
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Address Line | 3202 ROUTE 145 # 2
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City | PRESTON HOLLOW
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State | NY
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Zip | 12469-1806
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Country | US
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Telephone | 518-390-0045
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Fax |
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 007951-01
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License Number State | NY
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