Provider Demographics
NPI:1285684027
Name:STRATTON V.A. MEDICAL CENTER
Entity Type:Organization
Organization Name:STRATTON V.A. MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED HAND THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ALTON
Authorized Official - Middle Name:JOLYON
Authorized Official - Last Name:BRISPORT
Authorized Official - Suffix:
Authorized Official - Credentials:MA, OTR/L, CHT
Authorized Official - Phone:5186-262-5803
Mailing Address - Street 1:150 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12304-3903
Mailing Address - Country:US
Mailing Address - Phone:518-372-4303
Mailing Address - Fax:
Practice Address - Street 1:113 HOLLAND AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3410
Practice Address - Country:US
Practice Address - Phone:518-626-5803
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004751-1225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty