Provider Demographics
NPI:1093920464
Name:BRUSSA, ANA (OT)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:
Last Name:BRUSSA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:ANA
Other - Middle Name:
Other - Last Name:FERRER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OT
Mailing Address - Street 1:235 WASHINGTON AVE
Mailing Address - Street 2:#2
Mailing Address - City:WINTHROP
Mailing Address - State:MA
Mailing Address - Zip Code:02152-1301
Mailing Address - Country:US
Mailing Address - Phone:617-636-5632
Mailing Address - Fax:
Practice Address - Street 1:750 WASHINGTON ST
Practice Address - Street 2:#419
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1526
Practice Address - Country:US
Practice Address - Phone:617-636-5630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7829225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist