Provider Demographics
NPI:1093267387
Name:BROZAS, VANESSA MAE (OTR)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:MAE
Last Name:BROZAS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 WALNUT GROVE RD
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-1185
Mailing Address - Country:US
Mailing Address - Phone:404-518-7447
Mailing Address - Fax:
Practice Address - Street 1:318 WALNUT GROVE RD
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-1185
Practice Address - Country:US
Practice Address - Phone:404-518-7447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-02
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004154225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist