Provider Demographics
NPI:1114429834
Name:BROMBOS, KRISTEN (COTA)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:BROMBOS
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 1:7653 ENDRESS RD
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-7215
Mailing Address - Country:US
Mailing Address - Phone:716-208-6738
Mailing Address - Fax:
Practice Address - Street 1:7653 ENDRESS RD
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-7215
Practice Address - Country:US
Practice Address - Phone:716-208-6738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005813-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant