Provider Demographics
NPI:1114430261
Name:EYERMANN, BREANNA (COTA)
Entity Type:Individual
Prefix:MRS
First Name:BREANNA
Middle Name:
Last Name:EYERMANN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:BREANNA
Other - Middle Name:
Other - Last Name:PARRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:4711 WINDING WOODS LN
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-5457
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:283 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-1804
Practice Address - Country:US
Practice Address - Phone:716-725-7163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-13
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007392-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant