Provider Demographics
NPI:1285862466
Name:BRUTUS, NATASHA E (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:NATASHA
Middle Name:E
Last Name:BRUTUS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8815 144TH ST APT 2C
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-3201
Mailing Address - Country:US
Mailing Address - Phone:917-502-2552
Mailing Address - Fax:
Practice Address - Street 1:8815 144TH ST APT 2C
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-3201
Practice Address - Country:US
Practice Address - Phone:917-502-2552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-26
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY013706-1OtherOT LICENSE