Provider Demographics
NPI:1568767473
Name:IBARRA, BRUNILDA (COTA/L)
Entity Type:Individual
Prefix:
First Name:BRUNILDA
Middle Name:
Last Name:IBARRA
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:298 E 3RD ST
Mailing Address - Street 2:6
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-7846
Mailing Address - Country:US
Mailing Address - Phone:917-796-1870
Mailing Address - Fax:646-454-1415
Practice Address - Street 1:298 E 3RD ST
Practice Address - Street 2:6
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-7846
Practice Address - Country:US
Practice Address - Phone:917-796-1870
Practice Address - Fax:646-454-1415
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-24
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002431-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant