Provider Demographics
NPI:1629374905
Name:KAPLAN, BROCHA ETHEL (OTR/L)
Entity Type:Individual
Prefix:
First Name:BROCHA
Middle Name:ETHEL
Last Name:KAPLAN
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 1:912 CORNAGA AVE
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-5002
Mailing Address - Country:US
Mailing Address - Phone:718-327-1867
Mailing Address - Fax:
Practice Address - Street 1:912 CORNAGA AVE
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-5002
Practice Address - Country:US
Practice Address - Phone:718-327-1867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-02
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014544-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics