Provider Demographics
NPI:1417521121
Name:BICOS, JEFF CHERYLL ANNE (COTA)
Entity Type:Individual
Prefix:MS
First Name:JEFF CHERYLL
Middle Name:ANNE
Last Name:BICOS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MS
Other - First Name:CHERYLL
Other - Middle Name:ANNE
Other - Last Name:BICOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COTA
Mailing Address - Street 1:2620 GLENWOOD RD APT 1G
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-2232
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2620 GLENWOOD RD APT 1G
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-2232
Practice Address - Country:US
Practice Address - Phone:929-304-5357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007998224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant