Provider Demographics
NPI:1043982630
Name:SOODSMA, BRITTNEY LEE (OTR/L)
Entity Type:Individual
Prefix:
First Name:BRITTNEY
Middle Name:LEE
Last Name:SOODSMA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 STUTZMAN RD
Mailing Address - Street 2:
Mailing Address - City:BOWMANSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14026-1006
Mailing Address - Country:US
Mailing Address - Phone:920-905-9604
Mailing Address - Fax:
Practice Address - Street 1:95 STUTZMAN RD
Practice Address - Street 2:
Practice Address - City:BOWMANSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14026-1006
Practice Address - Country:US
Practice Address - Phone:920-905-9604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-01
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026037225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist