MEDICARE: BRUNETTE IMBERT OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	007729-1	NY

General Provider Information

NPI Number	:	1861631897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRUNETTE IMBERT OTR/L

Provider Business Mailing Address
First Line	:	1028 STAFFORD RD
Second Line	:
City	:	VALLEY STREAM
State	:	NY
Zip	:	11580-1822
Country	:	US
Telephone Number	:	718-314-8441
Fax Number	:	516-596-7515

Provider Business Practice Location Address
First Line	:	1028 STAFFORD RD
Second Line	:
City	:	VALLEY STREAM
State	:	NY
Zip	:	11580-1822
Country	:	US
Telephone Number	:	718-314-8441
Fax Number	:	516-596-7515

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2009
Last Update Date	:	02/15/2009

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