Provider Demographics
NPI:1720419476
Name:BRABANT, SUSAN (OTR)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:BRABANT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:M
Other - Last Name:BRABANT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MASSAGE THERAPY
Mailing Address - Street 1:188 NORTH DELAWARE AVENUE
Mailing Address - Street 2:
Mailing Address - City:NORTH MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758
Mailing Address - Country:US
Mailing Address - Phone:516-659-6707
Mailing Address - Fax:
Practice Address - Street 1:188 NORTH DELAWARE AVENUE
Practice Address - Street 2:
Practice Address - City:NORTH MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758
Practice Address - Country:US
Practice Address - Phone:516-659-6707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-06
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY63018509225X00000X
NY007808225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist