Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 004251-1 | NY |
N | 225X00000X | Occupational Therapist | 11079 | FL |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 004251-1 | NY |
N | 225XP0200X | Occupational Therapist - Pediatrics | 004251-1 | NY |
NPI | 1124245519 |
---|---|
Provider Name | Sharon Kaylie Brodsky |
First Address | Stony Brook, NY 11790-2804 |
Second Address | Stony Brook, NY 11790-2804 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2007 |
Last Update Date | 05/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8903271 | (05) | FL |