Provider Demographics
NPI:1093372518
Name:BRUTSKIY, ANGELA (COTA)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:BRUTSKIY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 S LAKE EMORY DR
Mailing Address - Street 2:
Mailing Address - City:INMAN
Mailing Address - State:SC
Mailing Address - Zip Code:29349-7257
Mailing Address - Country:US
Mailing Address - Phone:828-713-4430
Mailing Address - Fax:
Practice Address - Street 1:304 JACOBS HWY
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:SC
Practice Address - Zip Code:29325-7279
Practice Address - Country:US
Practice Address - Phone:864-833-2550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4937224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant