Provider Demographics
NPI:1104195452
Name:BRAHM, VICKI W (COTA)
Entity Type:Individual
Prefix:MS
First Name:VICKI
Middle Name:W
Last Name:BRAHM
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8439 MILLER HILL RD
Mailing Address - Street 2:
Mailing Address - City:AVERILL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12018-2608
Mailing Address - Country:US
Mailing Address - Phone:518-674-7075
Mailing Address - Fax:518-674-7096
Practice Address - Street 1:8439 MILLER HILL RD
Practice Address - Street 2:
Practice Address - City:AVERILL PARK
Practice Address - State:NY
Practice Address - Zip Code:12018-2608
Practice Address - Country:US
Practice Address - Phone:518-674-7075
Practice Address - Fax:518-674-7096
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004386-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant