Provider Demographics
NPI:1437340643
Name:BRONNER, SANDRA (OTR)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:BRONNER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2606 E 15TH ST
Mailing Address - Street 2:ROOM 203
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3828
Mailing Address - Country:US
Mailing Address - Phone:718-332-0080
Mailing Address - Fax:718-332-3365
Practice Address - Street 1:2610 E 18TH ST
Practice Address - Street 2:SUITE 4
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3622
Practice Address - Country:US
Practice Address - Phone:718-332-0080
Practice Address - Fax:718-332-3365
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012224225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics