Provider Demographics
NPI:1235730128
Name:VANBRUNT, JARED CHRISTOPHER (MS OTR/L)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:CHRISTOPHER
Last Name:VANBRUNT
Suffix:
Gender:M
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 E BROADWAY APT A1
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-4790
Mailing Address - Country:US
Mailing Address - Phone:631-793-5021
Mailing Address - Fax:
Practice Address - Street 1:2108 JOSHUAS PATH
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-4764
Practice Address - Country:US
Practice Address - Phone:631-761-6996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024598225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist