Individual
ANISSA BROCKWAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OCCUPATIONAL THERAPI
Contact information
Practice address
182 COFFEY ST, BROOKLYN, NY 11231-1026
(347) 385-7605
Mailing address
182 COFFEY ST, BROOKLYN, NY 11231-1026
(347) 385-7605
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
024074
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
061715422
DL
—
Enumeration date
10/18/2019
Last updated
10/18/2019
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